By Millie Brecheisen, physiotherapist in Basel. Updated: 1 October 2026.
Migraine without a headache? It sounds contradictory. Yet with vestibular migraine, dizziness, nausea or difficulty tolerating movement can take centre stage. Here, migraine describes a sensory process that extends beyond pain alone.
Migraine can mainly affect the vestibular system
Vestibular migraine is recognised as a common cause of recurrent spontaneous vertigo. An attack may combine spinning, rocking, nausea, motion sensitivity or disorientation. A headache need not accompany every episode. Light and sound sensitivity, a migraine history, motion sickness and visual sensitivity are often useful clues [1].
Recent research describes vestibular migraine as a problem of sensory processing involving migraine, vestibular and visual networks. CGRP, already important in other forms of migraine, also appears to contribute to interactions between trigeminal and vestibular pathways [1, 2].
Why diagnosis can take time
The presentation varies considerably. Some people have attacks lasting minutes or hours. Others mainly experience prolonged unsteadiness afterwards. Hearing tests, vestibular assessment or imaging may be normal between attacks. These results alone neither confirm nor rule out vestibular migraine.
Medical diagnosis depends on the history of the episodes, migraine features and exclusion of competing explanations. These include BPPV, Ménière’s disease, peripheral vestibular disorders, neurological causes and PPPD.
Treatment involves more than one tool
The approach depends on how often attacks occur and how severe they are. Migraine prevention may involve several medication families. Recent publications emphasise that the evidence is less robust than for other forms of migraine, although options are developing, including treatments targeting CGRP [2]. These decisions belong with the doctor or neurologist.
Sleep, regular meals, training load, physical activity and identifying personal triggers can also matter. The aim is to recognise reproducible patterns in the individual, rather than impose a universal list of forbidden foods.
Where does vestibular physiotherapy fit?
Physiotherapy is particularly relevant when difficulties remain between attacks: unsteadiness, head movement sensitivity, visual dependence, balance problems or avoidance of certain situations. A recent meta analysis reported a clinically relevant improvement in Dizziness Handicap Inventory scores following vestibular rehabilitation, but results varied greatly between studies [3].
An assessment in Basel can identify which functions can actually be trained and guide specific exercises. If migraine symptoms are currently unstable, exercise dosage needs particular care.
Symptoms that need another explanation
Sudden new hearing loss, a neurological deficit, persistent double vision, a sudden inability to walk or an unusual headache require medical assessment. Having migraine does not prevent another condition from developing.
Clinical points that help make sense of the assessment
Useful clues include recurrent vestibular episodes, a migraine history and migraine features during some attacks. Symptoms may last minutes to hours, sometimes longer during recovery. Between attacks, assess visual dependence, balance deficits and possible PPPD before assuming that every symptom is migraine.
A simple diary to make attacks easier to interpret
Recording a few details over several episodes can help the doctor and physiotherapist. You do not need to monitor every sensation all day.
- Duration of dizziness, pain and sensitivity to light or sound.
- The context: sleep, meals, menstruation, exercise and recent treatment changes.
- Between attacks: difficulty in shops, avoided movements and walking problems.
One apparent trigger does not prove a cause. The diary helps identify consistent links and distinguish attacks from ongoing discomfort.
A physiotherapy assessment in Basel
At the Basel clinic, physiotherapy mainly assesses what persists between attacks: balance, head movements and visual sensitivity. Care is coordinated with medical migraine treatment. An episode diary and neurological or ENT reports can help prepare for the first appointment.
Frequently asked questions
Can vestibular migraine occur without a headache?
Yes. Vestibular symptoms may dominate an attack while headache is absent or mild.
Do vestibular exercises cure migraine?
They do not address the migraine mechanism on their own. They may improve balance, movement tolerance and visual dependence when these remain problematic between attacks.
Can vestibular migraine and PPPD coexist?
Yes. Vestibular migraine can precede or maintain PPPD. Treatment then needs to account for both patterns.
Related articles
- Dizziness and vestibular rehabilitation in Basel
- PPPD: understanding persistent dizziness and its treatment
- Dizziness in supermarkets and on screens: understanding VID
- Ménière’s disease: what role can vestibular rehabilitation play?
Scientific references
[1] Villar-Martinez MD, Goadsby PJ. Vestibular migraine: an update. Curr Opin Neurol. 2024. Read the reference on PubMed.
[2] Calandre EP et al. An overview of the current and emerging treatment options for vestibular migraine. Expert Rev Neurother. 2024. Read the reference on PubMed.
[3] El Ahdab J et al. The effect of vestibular rehabilitation in the management of vestibular migraine in adults: A systematic review and meta-analysis. Headache, 2026 (published online in 2025). Read the reference on PubMed.
This information explains possible mechanisms and rehabilitation options. Diagnosis and treatment depend on an individual assessment.
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