Vestibular Migraine Explained: Causes, Symptoms, and How Rehab Helps

Have you ever felt dizzy, lightheaded, or off balance, only to be told that everything looks “normal”?
Maybe you’ve had spinning sensations or felt like you were moving when you weren’t. Sometimes it’s paired with headaches… but often it’s not.

If that sounds familiar, you might be dealing with vestibular migraine, a condition that affects how your brain processes balance, motion, and sensory information. Essentially, your brain becomes overly sensitive to certain "triggering" stimuli - for some people, it's certain foods or smells, for others there are motion or visual triggers. And here’s the tricky part: about half of people with vestibular migraine don’t actually get headaches. This makes diagnosis tough.

And that’s one big reason it’s often misdiagnosed as “vertigo,” “inner ear issues,” or even “anxiety.”

Let’s talk about what’s really happening - and more importantly, how targeted rehab and coaching can help you start feeling steady and confident again.

What Exactly Is a Vestibular Migraine?

Vestibular migraine is a type of migraine that doesn’t always play by the rules.
Instead of the classic throbbing head pain, you might experience:

• Dizziness or spinning (vertigo)

• Feeling unsteady or off balance

• Motion sensitivity - like feeling dizzy in a car, with repetitive bending movements, or fast head motions

• Blurry vision or discomfort with busy visual patterns

• Nausea or fogginess

These episodes can last anywhere from a few minutes to several hours (sometimes longer). You may have light or sound sensitivity, neck tension, or fatigue, even if your head doesn’t hurt.

Because the “migraine” in vestibular migraine comes from brain changes that affect how your inner ear and visual system communicate (not just pain signals), it’s possible to feel all the dizzy, spacey, disoriented sensations without the typical headache.

Why It’s Often Missed

If you’ve ever been told, “Your ear tests are normal” or “Your dizziness is probably anxiety,” you’re not alone.
Vestibular migraine doesn’t show up clearly on imaging or standard vestibular tests, and since many people don’t have head pain, it can take months (or even years) to get the right diagnosis.

But identifying it is key, because once you understand what’s going on, there are very real, evidence-based ways to retrain your system and manage these dizzy spells more effectively to reduce the impact on your life.

How Rehab Can Help You Rebalance Your System

While medication can play a role in managing migraine symptoms, research shows that rehabilitation and exercise-based interventions can be just as - if not more - powerful.

In fact, studies have shown that regular aerobic exercise can decrease migraine frequency as effectively as some preventive medications like topiramate (AKA Topamax, a common migraine prescription)(PMID 22058057).
Other research confirms that both aerobic and strength training programs can reduce migraine frequency and severity, improving energy and mood at the same time (PMID 36050669)(PMID 31262284).

That’s where rehab comes in.
Through customized, progressive exercise and movement training, we can help your brain and body learn to process balance and motion cues correctly again, lowering your “migraine threshold” and helping you return to normal activities with confidence.

What Treatment Looks Like

Every person’s vestibular migraine is different, but here’s what we can typically focus on during virtual coaching sessions:

1. Exercise Programming to Reduce Migraine Severity

You don’t have to train like an athlete, but consistent movement is powerful medicine for the brain.
We’ll design a plan that fits your space, schedule, and comfort level to help:

• Regulate blood flow and oxygen to the brain

• Improve energy and sleep quality

• Boost your body’s ability to tolerate triggers without tipping into symptoms

Over time, these changes help reduce both the frequency and intensity of migraine attacks.

2. Lifestyle and Trigger Coaching

We’ll work together to identify what lights up your migraine system and how to raise your threshold for those triggers.
That might include:

• Optimizing sleep and hydration

• Managing screen time and lighting

• Gradually reintroducing activities that once made you dizzy

• Structuring your day for more energy and less symptom flare-ups

Sometimes small adjustments, like consistent meal timing, gentle stretching, or planned recovery breaks, can make a huge difference.

3. Oculomotor and Visual Motion Retraining

Vestibular migraine often throws off how your eyes and inner ear work together.
If you get dizzy in the grocery store, scrolling your phone, or watching fast-moving visuals, we’ll use targeted eye-movement and visual retraining to rebuild your tolerance.
This might include smooth pursuit and saccade exercises, convergence training, or gradual exposure to visual motion - all done at your pace, with expert guidance to push progress but prevent symptom overload.

4. Motion Sensitivity and Balance Retraining

If you feel unsteady, wobbly, or “like you’re walking on a boat,” you’re not imagining it.
Your brain may have learned to avoid movement to prevent dizziness, but that avoidance actually reinforces sensitivity.
Through carefully guided habituation and balance challenges, we retrain your system to move confidently again.
You’ll learn how to:

• Tolerate head and body movements without dizziness

• Improve your balance in real-life settings

• Regain confidence with walking, turning, and multitasking

All of this can be done virtually, using simple home setups and individualized progressions.

Why Virtual Rehab Works

Virtual care makes vestibular migraine treatment more accessible than ever.
With online coaching, you can:

• Connect from anywhere - no travel, waiting rooms, or exposure to bright lights/sensory overload

• Receive individualized plans that adapt week by week as your symptoms change

• Have accountability and unlimited support between sessions

You’ll have everything you need - video demos, progress tracking, and direct communication - right at your fingertips.

Getting Started

If dizziness, imbalance, or motion sensitivity are limiting your life, it’s time to get answers and take back control.

Through personalized virtual rehab, we can help you:

• Understand your triggers and retrain your balance system

• Build strength and resilience to prevent future attacks

• Feel steady, focused, and confident again

→ Ready to take the first step?
Book your free discovery call to discuss your symptoms and see if vestibular migraine coaching is right for you.

Also, here is access to my free migraine tip sheet — packed with practical strategies to start implementing now.

References

• Varkey E et al. Exercise as migraine prophylaxis: a randomized study. Cephalalgia. 2011;31(14):1428–1438.

• Irby MB et al. Exercise interventions for migraine prevention: a systematic review. J Headache Pain. 2019;20(1):83.

• Kreutz C et al. Comparative efficacy of exercise interventions for migraine: a network meta-analysis. J Headache Pain. 2022;23(1):103.

• Lempert T, Neuhauser H. Epidemiology and diagnosis of vestibular migraine. Curr Opin Neurol. 2009;22(1):90–96.