What is vestibular migraine?
Vestibular migraine is a common cause of recurring vertigo. Episodes of dizziness, motion sensitivity and imbalance are linked to migraine, with or without a headache.
Care combines medical migraine management with vestibular rehabilitation.
What causes vestibular migraine?
The exact cause is not fully understood. It is linked to how the brain processes sensory signals during migraine. Common triggers include poor sleep, stress, skipped meals, dehydration, hormonal changes and certain foods.
Vestibular migraine often overlaps with persistent postural-perceptual dizziness (PPPD), and migraine is common in people with Mal de Débarquement syndrome. Telling these apart shapes the treatment plan.
Neck pain and headaches, too?
Neck pain and stiffness are common in people with migraine and can make symptoms worse. Treating the neck is often part of the plan.
Understanding Vestibular Migraines
Vestibular Migraine (VM) is a central nervous system sensory-processing disorder. Unlike classic migraines, you do not need to have a throbbing headache during an episode—VM frequently manifests as episodes of spontaneous or positional vertigo, rocking unsteadiness, severe motion sickness, light/sound sensitivity, and visual motion intolerance.
Why Standard PT Gyms Trigger Vestibular Migraines
Because the migraine brain has a lowered sensory threshold and heightened cortical excitability, aggressive generic balance exercises in a noisy, brightly lit gym can overwhelm your nervous system and trigger an attack. Our quiet, 60-minute 1-on-1 clinical environment allows us to pace your habituation below your symptom-flare threshold.
Common symptoms of vestibular migraine
- Episodes of vertigo lasting minutes to days
- Sensitivity to motion, scrolling screens or busy store aisles
- Headache or light and sound sensitivity, though not always
- Lingering imbalance or a foggy feeling between episodes
Not sure this matches? Take the 60-second dizziness self-check.
How we diagnose vestibular migraine in Cumming and Alpharetta
At North Atlanta Vertigo & Physical Therapy, serving Alpharetta, Cumming, Johns Creek and Suwanee, your first visit is a full 60-minute, one-on-one evaluation with our physical therapy team, led by Dr. Manan Patel, PT, DPT, a Certified Vestibular Specialist. To confirm vestibular migraine and rule out conditions that look similar, we record your eye movements with infrared video goggles and measure your balance on our BioSway computerized balance system. Testing can include:
- A detailed history, screened against published diagnostic criteria and coordinated with your physician
- Oculomotor and positional testing to rule out other causes such as BPPV
- Balance and visual-motion sensitivity testing
When to get urgent care
Specialized physical therapy treatment for vestibular migraine
At North Atlanta Vertigo & Physical Therapy, serving Cumming and Alpharetta, GA, Dr. Manan Patel and our physical therapists treat vestibular migraine with carefully dosed vestibular rehabilitation, habituation to motion and visual triggers, and neck care, coordinated with your neurologist or primary care physician. Every visit is 60 minutes, one-on-one, and we re-test as you improve.
Our Calibrated Vestibular Migraine Approach
- Paced Central Habituation Tracks: Step-by-step movement and head-turn exposures carefully titrated to expand your motion tolerance without provoking autonomic overload.
- Optokinetic & Visual Motion Desensitization: Controlled exposure to scrolling patterns and visual flow to reduce dizziness in grocery stores, traffic, and on digital screens.
- Upper Cervical & Autonomic Regulation: Manual therapy to release trigeminocervical tension in the upper neck paired with autonomic pacing strategies.
Your treatment plan
Coordinate care
We work alongside your neurologist or primary care doctor, who manages migraine medication and triggers.
Habituation
Graded exposure to the motion and visual triggers that bother you, at a pace you can tolerate, reduces sensitivity over time.
Balance and confidence
Balance training and pacing strategies to get you back to work, driving and exercise.
Recovery and what to expect
Improvement is usually gradual, over weeks to months, and works best alongside medical migraine management.
Tips for daily life
- Keep regular sleep and meal times
- Track triggers in a simple symptom diary
- Stay well hydrated
- Take regular screen breaks and limit fast scrolling during flare-ups
Frequently asked questions about vestibular migraine
Can I have vestibular migraine without headaches?
Yes. Many people have dizziness episodes with little or no headache.
Do I need a neurologist?
Diagnosis and medication are managed by a physician. We focus on reducing motion sensitivity and improving balance.
How is vestibular migraine different from BPPV?
BPPV causes brief spinning, usually under a minute, triggered by head position. Vestibular migraine episodes last minutes to days and often come with light or sound sensitivity, motion sickness or visual aura, sometimes with no headache.
Can physical therapy help vestibular migraine?
Yes. Vestibular rehabilitation reduces motion sensitivity and dizziness between attacks with habituation, gaze stabilization and balance training, dosed to avoid triggering a migraine, alongside care from your physician.
Related guides
- Vertigo, dizziness or lightheadedness? How to tell the differenceWhat spinning, rocking, woozy and faint usually mean, and when dizziness is an emergency.4 min read · Patients
- Concussion recovery: why complete rest isn't the answerWhy brief rest and gradual activity beat a dark room, and when to get rehab.3 min read · Patients
Browse all guides in our learning center
Questions patients ask
- What is subjective BPPV, when you have positional vertigo without visible eye movements?
- What is PPPD, and how does physical therapy retrain chronic rocking and swaying?
- Vestibular migraine vs. BPPV: can you have severe vertigo without a headache?
- Why do busy grocery store aisles, fluorescent lights and scrolling screens make me dizzy?
- Why do vestibular disorders trigger anxiety, and how do you break the dizziness-anxiety loop?
- Can vestibular therapy help severe motion sickness and car sickness in adults?
- How are cervicogenic headaches and occipital neuralgia treated when pain at the base of the skull triggers dizziness?
- Are TMJ problems, jaw pain, ear fullness and dizziness connected?
Related conditions
- Persistent dizziness (PPPD)A constant sense of rocking or swaying that does not settle.
- Mal de Débarquement (MdDS)A lingering rocking or bobbing sensation, often after travel.
- Concussion & post-concussion syndromeHeadaches, dizziness, fog and visual strain after a head injury.
- Vestibular rehabilitationHow testing and treatment work for every type of dizziness.
References
- Lempert T, et al. Vestibular migraine: Diagnostic criteria (Update). Journal of Vestibular Research. 2022.
Where to get treated
Book at either clinic. Same phone number, same team, same 60-minute visits.
Cumming clinic
Off GA-400 Exit 13 on Peachtree Parkway
Cumming, GA 30041
Alpharetta clinic
Inside Georgia Brain & Spine Physical Therapy
Alpharetta, GA 30022
Also serving Johns Creek, Milton, Roswell, Suwanee and nearby communities.
