Vertigo (dizziness) is a frequent symptom that accompanies migraine headache. Vertigo can occur during the aura phase, headache phase, or vertigo and headache can occur as separate isolated episodes. Rarely vertigo can be the only manifestation of a migraine attack (migraine-equivalent or aura without migraine headache). If an individual has chronic recurrent attacks of unexplained vertigo, the diagnosis of migraine should be considered.

The duration of the vertigo with each attack can vary. Since vertigo can occur with several common "inner ear" conditions, such as benign positional vertigo and Meniere's disease, the physician must obtain a detailed history and perform a thorough examination to understand the underlying cause for the vertigo. Since migraine is a common ailment, and vertigo occurs in at least 25% of individuals with migraine headaches, migraine with vertigo is a likely cause for vertigo in many patients.

If the vertigo precedes a typical migraine headache, then the diagnosis of migraine with vertigo may be straightforward. If the vertigo and headache occur independently, then the diagnosis of migraine with vertigo can be more complicated. A history of motion sickness in other family members or in the individual affected, or a family history of migraine headache may support the diagnosis of migraine with vertigo.

The management of migraine headache with vertigo is similar to the management of other migraine syndromes. Preventive therapy such as antidepressants, anti-seizure medications, anti-hypertensives including beta-blockers, calcium channel blockers, and diuretics, may reduce the frequency and intensity of the migraine events. If the events are infrequent, symptomatic medications to reduce dizziness, pain and nausea, such as benzodiazepines, may be used.

If you have vertigo with your migraine attacks or vertigo independent of your migraine attacks, then revealing this information to your physician may be quite helpful. Your physician may investigate other causes of vertigo and if no other cause is found, he or she may initiate treatment for migraine. Most of my patients who have migraine with vertigo have found a significant reduction in their events on various preventive medications.