Quick Answer
Vestibular Migraine is treated according to its own mechanism rather than as headache generally. Classification comes first, because the treatment approaches for the different headache types barely overlap. Studies that are indicated are read in-house by the ordering neurologist.
Part ofThis guide sits beneath headache and migraine, which covers the study itself, how it is performed and what the report should contain.
Headache and Migraine in Las Vegas and Henderson →Key Takeaways
- Vestibular migraine causes episodic dizziness or vertigo driven by migraine mechanisms rather than the inner ear.
- Many episodes involve little or no head pain, which is why it is frequently missed.
- Treatment is migraine management rather than vestibular treatment.
- Long-term vestibular suppressants treat the sensation while blunting the compensation the brain uses to recalibrate.
- Balance testing helps exclude a peripheral cause rather than confirming this diagnosis.
Migraine
Migraine is a neurological disorder in which attacks of head pain occur alongside other nervous-system symptoms such as nausea, light or sound sensitivity, and visual aura. It is a disorder of how the brain processes sensory input, not simply a bad headache.
How vestibular migraine is treated
Vestibular migraine causes episodic dizziness or vertigo driven by migraine mechanisms rather than by the inner ear. That distinction determines the entire treatment approach, and getting it wrong is common.
Why it is missed
Patients present with dizziness rather than headache, and many episodes involve little or no head pain at all. So the assessment goes down a vestibular pathway, balance testing is frequently normal, and the patient is told nothing is wrong. Meanwhile the pattern that identifies it, episodic attacks lasting minutes to hours with a personal or family history of migraine and sometimes light or sound sensitivity during them, is sitting in the history unremarked.
What treatment consists of
Migraine management rather than vestibular treatment. That means the same framework as any migraine: identifying frequency, addressing medication overuse, and preventive treatment where attacks are frequent enough to justify it. Vestibular suppressant medication, which is what many patients arrive taking, treats the sensation while doing nothing about the mechanism and taken long-term blunts the compensation the brain uses to recalibrate.
Where rehabilitation fits
Vestibular rehabilitation can help where a compensation problem has developed alongside, but it is not the primary treatment and used alone it frequently disappoints. The sequence matters: establish that the mechanism is migraine, treat it as migraine, and add rehabilitation for the residual rather than instead.
| Also considered | How it is distinguished |
|---|---|
| Tension-type headache | Pressing, bilateral pain without nausea, aura or movement sensitivity. |
| Cluster headache | Strictly one-sided, 15 minutes to about 3 hours, with tearing, nasal congestion or a drooping eyelid, and restlessness rather than stillness. |
| Medication-overuse headache | A pattern change: headaches become more frequent as acute medication use rises, and the history rather than a scan identifies it. |
| Secondary headache | Red flags — sudden 'worst-ever' onset, fever with neck stiffness, new deficit, or onset after head injury — prompt urgent imaging rather than a headache diagnosis. |
What the practice does
01
What brings people in
Frequent or changing headaches, attacks that are no longer controlled by what used to work, or a new headache pattern that needs an explanation.
02
What the evaluation settles
Which headache disorder the pattern fits, whether any red flag needs imaging, and which preventive and acute options are appropriate.
03
What you leave with
A named diagnosis where one can be made, a written acute and preventive plan, and a follow-up interval to judge whether it is working.
Separating it from inner-ear causes
Balance testing is performed in-house and is genuinely useful here, not because it confirms vestibular migraine but because it helps exclude a peripheral cause. A normal study in a patient with episodic dizziness and a migraine history is informative rather than a dead end, described on the VNG page.
Treated as migraine
Frequency established from a diary, medication overuse checked, and preventive treatment considered where attacks are frequent enough. Both in-office preventives are available. Bring a month of dates recording episodes rather than headaches, since in this condition the dizziness is the attack.
Both offices
Assessment, balance testing and in-office treatment are all available at both addresses on the locations page. Note that balance testing requires someone to drive you home.
The first 30, 60 and 90 days
Step 1
First visit
History and neurological examination, a review of records and prior imaging, and a decision on which studies are actually indicated. You leave with the plan, not just a referral.
Step 2
Within 30 days
Indicated in-office studies are performed and interpreted by the neurologist who ordered them, in our AANEM-accredited laboratories. Results are explained in plain language.
Step 3
60 to 90 days
Follow-up to judge whether the plan is working, adjust it, and coordinate with your referring clinician. Where a diagnosis needs time to confirm, this is where it is revisited.
Not sure which headache type you have?
Bring a month of dates and what you took. Classification comes before treatment.
The Bottom Line
Treated as migraine rather than as an inner-ear problem. A normal balance study in someone with episodic dizziness and a migraine history is informative rather than a dead end.
Frequently Asked Questions
What counts as chronic migraine?
Fifteen or more headache days a month, with migraine features present on at least eight of them. It is a numerical definition rather than a description of severity, and it determines candidacy for several preventive treatments. Episodic migraine, meaning fewer than fifteen headache days a month, is managed differently, so establishing which side of that line you sit on changes which options are open to you.
Why does frequency matter more than severity?
Because treatment decisions run on how many days a month are affected rather than how bad the worst day was. Most people underestimate their count substantially when reconstructing from memory, which is why a month of dates is worth more than any description. A written record of dates is the only thing that settles the count reliably.
Could my sinus headaches be migraine?
Frequently. Migraine activates a pathway producing nasal congestion, facial pressure and tearing, which are exactly the symptoms people attribute to sinuses. Recurrent sinus headache without infection is uncommon, so episodic attacks with clear intervals point toward migraine. Sinus imaging in these patients is frequently normal, and that is often the point at which migraine is finally considered.
Can painkillers make my headaches worse?
Yes. Acute headache medication taken frequently enough can sustain the headaches it was taken to relieve. It is common and not a failure of willpower, but addressing it usually has to come before or alongside a new preventive. The pattern to watch for is acute medication on more than about ten days a month, sustained across several months.
Why was my balance test normal?
Because the mechanism is migraine rather than the inner ear. A normal study is informative here rather than a dead end: it helps exclude a peripheral cause and supports treating the condition as migraine. Treating it as migraine, rather than continuing to look for an ear cause, is usually what changes the picture.
Do I need to have headaches to have this?
No, and that is why it is missed. Many episodes involve little or no head pain. What identifies it is the episodic pattern lasting minutes to hours alongside a personal or family history of migraine. Attacks can be set off by head motion or by visual movement, and a diary noting what preceded each one helps considerably.
Can I be treated if imaging has already been done and was normal?
Yes, and a normal scan is the expected finding in migraine. Imaging looks for a structural cause; it does not diagnose or exclude a headache disorder, which is established from the pattern. Bring the report rather than repeating the scan, because knowing it was normal changes what still needs considering.
Will I have to stop the medication I am using now?
Not abruptly, and not without a plan. Where an acute medication is being taken often enough to be sustaining the headaches, reducing it is planned deliberately alongside starting a preventive, because doing one without the other usually fails. Bring the bottles so the actual pattern can be seen rather than estimated.
How many headache days should I record before coming in?
A month is ideal and two weeks is useful. Record the date, roughly how bad it was, and what you took including anything bought without a prescription. That record is what establishes frequency, and frequency rather than severity decides which treatments are open to you, so it does more work than any description can.
How long does a first appointment take?
Longer than a routine primary care visit, because most of it is history taking and that is the part carrying the diagnosis. A physical examination follows. Allow rather more time in your day than the slot itself suggests, since it is better not to be watching the clock during the examination or the explanation afterwards.
How this page was sourced
Practice facts come from Clinical Neurology Specialists directly: that Botox for chronic migraine and CGRP therapy are both available in-office, and that the practice performs no cosmetic injections and runs no interventional pain programme. Clinical context is sourced to the organisations listed below.
No named agents, response rates, reduction percentages or dosing appear, because selection is a clinical decision and response varies between individuals. Treatment approaches are described by class and mechanism rather than by product. No outcome is promised. Scope is adults 18 and older.
Change log
- 2026-07-28 — page published; clinical content reviewed.
- 2026-07-28 — last reviewed against AAN, AANEM and NINDS guidance; internal links and schema verified.
- Review cadence: quarterly, or sooner if guidance changes.
How to cite this page
Clinical Neurology Specialists. “What is the Trusted treatment for vestibular migraine.” Reviewed 2026-07-28. https://www.cnsnevada.com/conditions/headache-migraine/what-is-the-best-treatment-for-vestibular-migraine/
References
- American Headache Society — classification and clinical guidance for headache disorders.
- American Academy of Neurology — practice guidance on preventive treatment.
- National Institute of Neurological Disorders and Stroke — the reference catalogue of nervous-system disorders.
This page is for general information about a Clinical Neurology Specialists office and is not medical advice, a diagnosis, or a treatment recommendation. It does not create a physician-patient relationship. Adults 18 and older. For an active stroke, a first-time or prolonged seizure, sudden severe headache, sudden weakness, sudden vision loss, or a head injury with loss of consciousness, call 911 or go to the nearest emergency department.