There are no "universal" triggers for those with migraine, but certain factors do seem to affect patients more than others. This generally holds true for those with specific migraine types too, including vestibular migraine, whose distinguishing feature is dizziness and vertigo. And there are some unique complications as well that must be taken into account. The top triggers of vestibular migraine, according to research, include:
Stress always floats to the top of any "migraine triggers" list, and it is no different for those with vestibular migraine. Even with the variable characteristics of migraine attacks, estimates still suggest that nearly half of those with migraine-related vertigo are induced by increasing stress. And of course we know that those with any type of migraine are at a greater risk for stressful reactions and other emotional symptoms.
We have extensive knowledge of the negative role that light plays in migraine, which makes it unsurprising that is included as a leading trigger here. Light sensitivity or photophobia is already a diagnostic signal for vestibular migraine, and exposure to high-intensity lighting has also been connected to general dizziness symptoms, regardless of condition.
Lack of Sleep
Sleep disturbances can bring on vestibular attacks in more than 25% of migraine patients, particularly first thing in the morning or in the middle of the night. Researchers do not know exactly why this occurs, but they believe that there are several migraine pathways that are activated when sleep is disrupted.
One of the more subjective triggers revolves around changes in the weather, however it still is reported by a significant percentage of those with migraine-related vertigo. In a 2019 analysis, incoming storm systems were the most frequent weather-related issue to cause vestibular attacks, although changes in season are also thought to contribute to this process.
Visual and Motion Triggers
The eye-to-brain system is highly sensitive for people with migraine (as evidence by the high proportion of those with photophobia), and this is especially true for people with a vestibular component. For example, vestibular migraine attacks can be triggered by the following stimuli:
- External motion such as moving vehicles, movies or computer screens
- Visually "busy" or "cluttered" environments, including shopping malls and grocery stores
- High-contrast patterns like flashing lights or even striped images
And all of these have been shown to be the biggest factors in the development of vestibular-specific symptoms, which includes dizziness, vertigo and lightheadedness, among others.
Given the high percentage of women who are affected by migraine and other headache disorders, biological changes involving the menstrual cycle can have a major impact on attacks. In fact, anywhere from 20-40% of patients with vestibular migraine have acknowledged that these hormonal fluctuations have triggered at least some of their symptoms.
Excessive Head Motion
Another unique stimulant for vestibular episodes has to do with head motion, which might affect more than 80% of individuals with the condition. This can be as simple as turning one’s head too quickly or shifting it from one view to another repeatedly.
Food and drink consumption is another common migraine trigger that equally impacts those with migraine-associated vertigo—perhaps even as many as half of patients. More specifically, skipping meals, drinking alcohol or red wine, and caffeine intake are among the most likely behaviors to initiate attacks, according to research.
Although less prominent than others, exercise can still cause problems for people with this subtype of migraine. Although there does not appear to be additional risk, we have to remember that exercising often incorporates head, neck and other sensitive movements for those with vestibular migraine.
Much like light sensitivity and visual disorientation, sound can play a prominent role in the onset of vestibular migraines. Scientists have repeatedly connected the migraine process with sensory processing, and many with the headache disorder report comparable levels of sensitivity to both light and noise. Although light may be a bigger threat for vestibular attacks, rarely do they exist in isolation.
It's important to remember this is just a short list of the leading triggers associated with vestibular migraine, and in fact there may be countless more that affect patients just as prominently: fatigue, strong odors or airline travel, to name a few. We encourage you to work with your neurologist or headache specialist to identify those factors that are causing trouble for you.
Read more about migraine triggers:
Beh SC, Masrour S, Smith SV, Friedman DI. The Spectrum of Vestibular Migraine: Clinical Features, Triggers, and Examination Findings. Headache. 2019 Feb 8. doi: 10.1111/head.13484. [Epub ahead of print]
Vuralli D, Yildirim F, Akcali DT, Ilhan MN, Goksu N, Bolay H. Visual and Postural Motion-Evoked Dizziness Symptoms Are Predominant in Vestibular Migraine Patients. Pain Med. 2018 Jan 1;19(1):178-183. doi: 10.1093/pm/pnx182.