Dizziness, light and noise sensitivity point doctor to vestibular migraine

A 35-year-old company manager repeatedly felt the room spin whenever she worked. Office lighting and ordinary conversations became unbearable during attacks, yet several medical examinations showed no abnormality. A referral to neurology eventually led to a diagnosis of vestibular migraine.

Chen You-jia, a neurologist at Cathay General Hospital, said vestibular migraine affects about 1% to 2.7% of the general population. It accounts for more than 10% of patients seen in dizziness or headache clinics. The condition is linked to overactivation and sensitivity in the trigeminal nerve system, which can affect the vestibular system and trigger dizziness.

Attacks may begin without warning and cause a spinning sensation or the feeling that the person or surroundings are moving. Symptoms can last from several minutes to 72 hours. Some patients experience sensitivity to light or sound, while others see flashes or zigzag-like visual disturbances before an attack.

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Vestibular migraine does not necessarily cause a headache.

The doctor said vestibular migraine does not necessarily cause a headache. More than half of patients may have no headache during a dizziness episode, making the condition harder to identify. Under international diagnostic criteria, doctors look for repeated moderate to severe vestibular symptoms, a current or past history of migraine, and migraine-related features in at least half of the episodes, while ruling out conditions such as Ménière’s disease and positional vertigo.

Treatment can include anti-dizziness, anti-nausea or migraine medication during acute attacks. Patients with frequent episodes, such as more than once a week, or a major decline in quality of life may be assessed for preventive medication. Vestibular rehabilitation uses gaze-stability, balance and gait exercises to help the brain adapt to vestibular signals. Chen also advised regular sleep, sufficient water, moderate exercise and attention to possible food triggers, including cheese, chocolate, alcohol, excess caffeine and some processed or fermented foods.

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If dizziness repeatedly occurs, especially with headache, sensitivity to light or noise, or a history of migraine, people should seek further evaluation.