Vestibular migraine vs. BPPV: can you have severe vertigo without a headache?

How do vestibular migraine and BPPV differ?

• Duration: BPPV spells last seconds to a minute; vestibular migraine episodes last minutes to days¹
• Triggers: BPPV is triggered by head position; migraine by sleep loss, stress, hormones, certain foods, screens or weather
• Other symptoms: migraine brings light and sound sensitivity, aura or motion sickness
• Testing: BPPV shows characteristic positional nystagmus; vestibular migraine usually does not

What are the diagnostic criteria for vestibular migraine?

The Bárány Society criteria require at least five episodes of moderate or severe vestibular symptoms lasting five minutes to 72 hours, a history of migraine, and migraine features, such as headache, light and sound sensitivity or visual aura, with at least half of the episodes¹. Diagnosis and medication management sit with your physician or neurologist.

How does vestibular therapy help vestibular migraine?

Therapy reduces motion sensitivity and the dizziness between attacks with habituation, gaze stabilization and balance training, dosed to avoid triggering a migraine. We also address neck pain and posture, which often aggravate migraine, and help you track triggers. We rule out BPPV with infrared goggles, since the two can occur together.

Where can I get vestibular migraine therapy in Alpharetta or Cumming?

We see patients with vestibular migraine from Alpharetta, Johns Creek, Milton, Cumming and Suwanee in 60-minute, one-on-one visits, and work alongside your neurologist or primary care physician.

Where can I get help in Alpharetta, Cumming and nearby?

Dr. Manan Patel, PT, DPT, TPS and our team of physical therapists see patients from Alpharetta, Johns Creek, Milton, Roswell, Cumming, Suwanee, Sugar Hill, Buford, Duluth and Forsyth County at two North Atlanta clinics. Every visit is 60 minutes, one-on-one, and urgent appointments are available within 48 hours. We are in-network with Traditional Medicare, BCBS / Anthem and Tricare, and offer a $129 rate per visit for self-pay and out-of-network plans. Not sure where to start? Take the free symptom self-check, or visit our Alpharetta clinic or Cumming clinic page.

Related care

Related questions

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References

1. Lempert T, et al. Vestibular migraine: Diagnostic criteria (Update). Journal of Vestibular Research. 2022.
2. Bhattacharyya N, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology–Head and Neck Surgery. 2017.

Answered by Dr. Manan Patel, PT, DPT, TPSDoctor of Physical Therapy, Certified Vestibular Specialist and one of the few certified Therapeutic Pain Specialists in North Atlanta, with 15+ years of outpatient care. About Dr. Patel

This answer is general education, not a diagnosis or a substitute for an examination. If you have new or worsening symptoms, contact your doctor. Call 911 for sudden severe dizziness with trouble speaking, weakness, numbness, double vision or a severe headache.