Can You Have a Vestibular Migraine Without a Headache?

Yes, you absolutely can. In fact, research shows that up to 64% of people with vestibular migraine don't experience a headache during their vertigo episodes [1]. This is one of the most misunderstood facts about vestibular migraines — and it's exactly why so many people go years without getting the right diagnosis.

If you've been dizzy, off-balance, or struggling with vertigo but keep getting told "it can't be migraines because you don't have headaches," you're not alone. And you're not imagining things.

The word "migraine" is misleading. It makes everyone — including many doctors — assume head pain is required. But vestibular migraines are a neurological condition that primarily affects your balance system, not your head. For many people, dizziness is the migraine. Let's talk about what that actually looks like and why it matters for getting the help you need.

Why Vestibular Migraines Without Headaches Get Missed

Here's a statistic that might make you feel validated and frustrated at the same time: only 10-21% of people with vestibular migraine are ever correctly diagnosed [2]. That means the vast majority of people with this condition are walking around with the wrong diagnosis — or no diagnosis at all.

Why does this happen?

When you show up to a doctor's office complaining of dizziness or vertigo without a headache, vestibular migraine often isn't even on their radar. Instead, you might be told you have:

• BPPV (benign paroxysmal positional vertigo)

• Meniere's disease

• "Vertigo of unknown origin"

• An inner ear problem

• Anxiety

Sound familiar?

One case study published in a medical journal described a 35-year-old woman who went 10 years with recurrent vertigo before finally being diagnosed with vestibular migraine — all because she didn't have headaches during her episodes [1]. Ten years of her life spent confused, dismissed, and searching for answers.

Even specialists miss it. Research shows that 19% of ENT doctors say they've never treated a patient with vestibular migraine [3]. That's not because these patients don't exist. It's because they're not being recognized.

The diagnostic criteria for vestibular migraine do require a history of migraine at some point in your life — but not during every episode. You might have had classic migraines with headaches in your twenties, and now in your forties, you're getting vertigo attacks without any head pain. That still counts. The migraine brain doesn't always show up the same way twice.

What Vestibular Migraine Actually Looks Like (Without the Headache)

If it's not a headache, what should you be looking for?

Vestibular migraine can show up as any combination of these symptoms:

• Vertigo or spinning sensations — can last anywhere from minutes to days

• Dizziness or feeling "off" — that hard-to-describe sense that something isn't right

• Sensitivity to light (photophobia) — even without a headache

• Sensitivity to sound (phonophobia)

• Nausea or vomiting

• Feeling worse in busy visual environments — like grocery stores, malls, or while scrolling on your phone

• Motion sensitivity — trouble in cars, trouble watching action movies

• A rocking or swaying sensation — like you're on a boat

• Brain fog or difficulty concentrating

You might also notice patterns that point toward a migraine connection:

• History of motion sickness as a child — this is a big one

• Family history of migraines — even if you don't get classic migraines yourself

• Symptoms that fluctuate with sleep, stress, hormones, or certain foods

• Episodes that come and go — rather than constant 24/7 dizziness

If you're nodding along to several of these, vestibular migraine deserves a closer look — whether or not your head ever hurts.

Vestibular Migraine vs. BPPV vs. Meniere's Disease

One reason vestibular migraine gets misdiagnosed is that it can look like other vestibular conditions. Here's a quick way to think about the differences:

BPPV (Benign Paroxysmal Positional Vertigo):

• Brief spinning episodes — usually under one minute

• Triggered by specific head movements: rolling over in bed, looking up, bending down

• No light or sound sensitivity

• Treatable with repositioning maneuvers like the Epley maneuver

Meniere's Disease:

• Episodes that include hearing loss, ear fullness, or ringing in the ears (tinnitus)

• Usually affects one ear

• Episodes can last 20 minutes to several hours

Vestibular Migraine:

• Episodes can last minutes to days — much longer than BPPV

• Often includes light sensitivity, sound sensitivity, or nausea

• History of migraines at some point in your life (even decades ago)

• May have motion sensitivity or visual triggers

• Headache is not required

Here's the tricky part: these conditions can coexist. It's entirely possible to have BPPV and vestibular migraine, or Meniere's disease with a migraine component. This is why working with a specialist who understands the overlap is so important.

What You Can Do About It

If you suspect you might have vestibular migraine — especially the kind without headaches — here's where to start:

Find a provider who understands vestibular migraine. This might be a neurologist, a neuro-otologist, or a vestibular physical therapist. The key is finding someone who won't dismiss the possibility just because you don't have head pain.

Consider vestibular physical therapy. Even without medication, vestibular rehabilitation can help your brain adapt and reduce your symptoms. A vestibular PT can also help identify whether there's a BPPV component or other factors contributing to your dizziness.

Pay attention to lifestyle factors. Vestibular migraines respond to many of the same triggers as classic migraines:

• Sleep — too little or too much can trigger episodes

• Hydration — dehydration is a common culprit

• Stress — easier said than done, but it matters

• Food triggers — caffeine, alcohol, aged cheeses, and processed foods affect some people

• Hormonal changes — many women notice patterns around their menstrual cycle

Keep a symptom diary. Tracking when your episodes happen, what you ate, how you slept, and what was going on in your life can help identify patterns you might otherwise miss.

Don't give up. If you've been dismissed because "you don't have headaches," that doesn't mean your symptoms aren't real or treatable. It means you haven't found the right provider yet.

Frequently Asked Questions

Can vestibular migraine cause dizziness every day?

Yes, some people experience daily or near-daily symptoms, especially if their vestibular migraine is undertreated or if triggers aren't being managed. Others have episodic attacks with symptom-free periods in between. The pattern varies from person to person.

Do I need medication for vestibular migraine?

Not necessarily. Many people improve significantly with lifestyle modifications, trigger management, and vestibular physical therapy. Medication can be helpful for some people, especially those with frequent or severe episodes, but it's not the only option.

Can vestibular migraine go away on its own?

Vestibular migraine tends to be a chronic condition, but symptoms can improve dramatically with proper treatment. Some people have long periods of remission. The key is getting the right diagnosis so you can manage it effectively.

I had migraines as a teenager but not anymore. Could I still have vestibular migraine?

Absolutely. Vestibular migraine often shows up years or even decades after someone's last classic migraine headache. The migraine brain can shift how it manifests over time — from head pain to dizziness — and that history still counts toward the diagnosis.

You Deserve Answers

If you've been struggling with dizziness, vertigo, or that constant "off" feeling — and you've been told it can't be migraines because you don't have headaches — please know this: your symptoms are real, they have a name, and they can get better.

At Dizzy Free PT, we specialize in vestibular conditions, including vestibular migraine. We've seen how life-changing it can be when someone finally gets the right diagnosis after years of searching.

If you're in the Fishers or Indianapolis area and ready to find out what's really going on, we'd love to help. Give us a call at (317) 804-1222 or schedule a free consultation to talk through your symptoms and see if we're the right fit.

You don't have to keep wondering. You don't have to keep being dismissed. And you definitely don't have to have a headache for your symptoms to be valid.

We do more than treat symptoms — we listen, dig deep, and help you understand what's really going on. Through expert care, honest guidance, and a whole lot of support, we help you move from feeling overwhelmed to steady, confident, and back in control.

References

Maita H, et al. "Vestibular migraine without headache treated with lomerizine: A 35-year-old woman undiagnosed for 10 years." Clinical Case Reports. 2020. PMC7388671
Formeister EJ, et al. "The Epidemiology of Vestibular Migraine: A Population-based Survey Study." Otology & Neurotology. 2018;39(8):1037-1044.
Sohn JH. "Recent Advances in the Understanding of Vestibular Migraine." Behavioural Neurology. 2016. PMC5086357