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So you think you might have vestibular migraine – what do you do? Who are the best doctors? How do you get on the path that feels steady again? This is the vestibular migraine guide for you – complete with all the personal patient advice that WebMD can’t give you.

An infographic guide on how to get diagnosed with vestibular migraine.

Many of us didn’t know what was happening to us when we began to experience many symptoms like vertigo, imbalance, derealization, and brain fog…and neither did our primary care doctors.

If you’ve read my vestibular migraine story, you’ll know I started out with a primary care doctor who told me I was just stressed. Then an ENT doctor who thought it was a neuritis and would go away. Then to several neurologists who said I just had anxiety. There was that vestibular rehab clinic that told me I probably had a perilymph fistula too.

As we bounce around from doctor to doctor, never getting answers, the problem begins to feel insurmountable. I put together this little guide that can help you know where to start and what the process might look like.

Table of Contents

Review The Diagnostic Criteria

First of all, read this post about common vestibular migraine symptoms and the diagnostic criteria.

Do any of these symptoms match yours? If so, it could be vestibular migraine or another vestibular disorder, like Meniere’s, MDDS, or PPPD. Often times patient can have two of these disorders at the same time.

Since vestibular disorders can mimic each other it’s important to be properly diagnosed by a physician familiar with these disorders and not from google or reddit/facebook groups.

For vestibular migraine, a big indicator is often sound and light sensitivity, how long your episodes are, and any migraine history with you or your family.

The migraine history can be a bit tricky, because so many people don’t realize you can have migraine attacks without head pain, so you may not realize you actually have a history.

Find The Right Doctor

Find a doctor that knows what they are doing and be prepared to wait. Unfortunately there are so few that really know how to treat this and many have long wait lists. It tends to be much faster if the doctor does not accept insurance.

If you want to start with your primary care doctor – go for it! I find this works for some of my followers who have a good relationship with their providers and the doctors are willing to try new things. But if you’re hitting a wall and feel out of options, it’s time to try an expert. Trust me, you are never actually out of options – the provider’s expertise is just not the right fit for you.

In my experience, I wish I would have paid more up front to fast forward to the doctor I really needed to see, saving myself a lot of money in copays in the long run. You also may need a referral to one of these doctors from a primary care doctor.

Keep in mind that not all neurologists or ENT’s know how to treat vestibular migraine. Some are just not very experienced with it or don’t have enough knowledge in this area to understand the nuance that comes with diagnosis and treatment. The most reliable choice is a neuroTologist – who specializes in the inner ear or a headache specialist (yes, even if you don’t get “headaches”).

Doing a little research and calling around can be helpful. Most doctors will mention what they treat on their website, but if they don’t, call and check with their office to see vestibular migraine is something the doctor is familiar with.

8 years ago my neurologist, Dr. Beh, had a 7 month wait list, but I was persistent and kept calling about cancellations. Because of this, I was able to get in earlier. Put your name on the wait list while you search for other options, and be open to travel for the best care. These days many of these physicians will do teleconference!

Vestibular Migraine Doctors

The following are doctors who treat vestibular migraine that I have either seen personally, worked with, or have come highly recommended by patients. These are not the only people who can treat VM, you may be able to find a good doctor locally. If you have, please let me know!

Telehealth/online options

These doctors may be limited in treatments depending on your location. Occasionally they can work with a current provider to give prescription recommendations.

  • Neura Health Discount code is DIZZYCOOK15 for $15 off your first month. May be limited on treatments depending on your state.
  • Dr. Trupti Gokani – Make a request through her website. Dr. Gokani works with medications but also combines them with natural treatments. If you’re wanting to treat this from a holistic perspective, I highly recommend.
  • Dr. Shin Beh – Sees patients online but only in Alabama, Arizona, Colorado, Florida (excluding Miami-Dade county), Georgia, Kentucky, Michigan, New Jersey, Ohio, Oklahoma, Tennessee, Texas, Virginia, and Washington. Will also see international patients.
  • Dr. Deborah Friedman – Telehealth in Texas and NY – see her FAQ for more info.

The doctors who I keep on this list overall have positive reviews, however, this may not mean they’re the right fit for you. Occasionally I get poor feedback on some, so I always weigh that with the good for these recommendations. Please understand that doctors are just like us and they have bad days too!

I find many of them have preferences for certain types or treatments or medications. For instance, Dr. Beh is one of the most creative when it comes to medications, and loves to try new things to get the best result for the patient. He also has a good sense of humor! People love Dr. Steenerson’s bedside manner and feel very heard when seeing her.

Others enjoy Dr. Gokani’s blend of Ayurvedic and traditional medicine, emphasizing mindset and holistic strategies. Dr. Deborah Friedman is incredibly knowledgeable with all her years of leading research. She’s an expert in visual issues and also other things that cause dizziness, like CSF leaks. If one doctor doesn’t fit your goals, it’s ok to try a different one. It’s like finding a partner!

Another thing to be aware of is that if you see an ENT for vestibular migraine, they cannot give you certain treatments that a headache specialist or neurologist can, like Botox. Many of them have to refer out of clinic for certain migraine medications or treatments that fall out of their scope.

International Vestibular Migraine Doctors

Prepare for Your Appointment

Before your visit, keep a journal of daily symptoms. Mark down everything, even if you think it’s not important. What was your level of dizziness that day? Did you fall? What does your diet look like?

Apps like Migraine Buddy can help with this and will even summarize it for the month for you. I just kept an old fashioned journal.

Pick out the symptoms you have from the vestibular migraine symptom guide and use them to describe your feelings when with your doctor.

Other things to note:

  • Does your family have a history of migraine, even if just occasional? Any complaints of sinus pain, dizziness, or problems with their eyes?
  • Did you get car sick as a kid or have abdominal pain, discomfort, or tummy aches?
  • Do you notice any light or sound sensitivity?
  • Severity – does the level of dizziness change or stay constant?
  • What helps the dizziness and what makes it worse?

Just because you do not get “headaches” does not mean you don’t have vestibular migraine. I was diagnosed without a single episode of head pain.

Testing for Vestibular Migraine

Vestibular testing and an MRI will most likely be involved in your appointment, but it is actually not necessary to diagnose vestibular migraine.

These tests may include an MRI, and VNG/ENG, a VEMP test, a hearing test and a rotary chair test. Your doctor might also perform a Dix Hallpike or Epley maneuver, but these will only work on BPPV. BPPV vertigo is a much shorter episode than migraine.

All of these tests are checking for other vestibular disorders, which can also occur along with vestibular migraine. An MRI is ruling out any other neurological issues. These tests do not confirm or diagnose vestibular migraine. To be diagnosed with vestibular migraine, you must meet some of the diagnostic criteria.

Treatment Options

Here are a few things I wish someone would’ve told me at the start of my vestibular migraine journey. You can see my own vestibular migraine treatment plan for an idea of what to expect.

Be open to medication – Depending on the severity of your dizziness, medication is sometimes the fastest way to feel better. Your options will most likely be an SSRI/SNRI, beta blockers, antidepressants, or anticonvulsants. Anti-CGRP meds and Botox are typically reserved for later in the process, if you cannot tolerate certain meds, but this is typically because of insurance requirements. Some doctors may be able to help you find a workaround or get you discounts, like through manufacturers coupons.

Be informed, but don’t research too much on side effects – I find if you go down the rabbit hole of researching medications, you hear the worst of the worst stories. The thousands of people who have this drug working for them don’t go online to post about how happy they are. They’re out living their lives.

Here is a medication flow chart that Dr. Hain uses for vestibular migraine, but remember medications are not one-size-fits-all. For a full breakdown of new treatments, watch this interview with Dr. Beh. Remember that medications can sometimes take 3-4 months to show improvement. Injectables and Botox can sometimes take 6-12 months.

Acute treatments are needed to help with really bad days – Discuss acute medications like rizatriptan, antihistamines, and certain benzodiazepines, which can be used as rescue meds for bad attacks or when traveling or with vertigo attacks.

Add in natural treatments for best results – These are things like devices (Cefaly (discount is dizzycook), Truvaga, or GammaCore), motion sickness bands and/or glasses, plus the proven supplements for migraine prevention like magnesium, B2, and CoQ10 should be discussed. Your doctor will decide what combo and dosage is best for you. The right treatment plan for me got me my life back.

Be careful with vestibular therapy – Your doctor may suggest VRT (vestibular rehab therapy). This is just therapy that helps retrain your vestibular system to accept motion without causing dizziness.

If you’re very sensitive to certain head movements, visual stimuli, or positions, this therapy can be helpful. It can be simple movements, like looking from left to right continuously. Or turning your head while focusing on a dot. More complex movements may involve bouncing a ball while your eyes follow it. Or bending over and picking an item up off the floor. 

It is important to note that vestibular therapy can sometimes make symptoms worse if you try it while your brain is overly sensitive from vestibular migraine. If you’re having 24/7 symptoms, it’s typically best to start with migraine treatment first, then add in vestibular therapy once things have calmed down. This is why it’s important to seek out thoughtful care with the right team.

Formulate a plan – If you’re not seeing an improvement in 2-3 months, what does your doctor suggest to try next? 

Dietary changes – I focus a lot on diet here, but it’s just one part of the treatment plan. There are many doctors who don’t believe diet has an effect on migraine, but most of the top ones listed above do, at the very least, believe that a low tyramine, additive-free diet can be beneficial for migraine.

If elimination sounds stressful to you or you already feel restricted, you’ll love my Mediterranean Migraine Diet book in partnership with Dr. Shin Beh. It focuses on foods to include to support your brain health and is was developed from new research on omega-3’s and migraine.

Books for Vestibular Migraine

You must read Heal Your Headache, The Dizzy Cook, and Victory Over Vestibular Migraine.

Even if you don’t get headaches (like I didn’t), Heal Your Headache is still worth a read. It could use an update, like some of the information about decaf coffee and rebound days is outdated, but it’s so incredibly helpful.

Dr. Buchholz touches on vestibular migraine, but that’s not why you buy this book. It can help you understand big picture thoughts on medications, the threshold theory, and how Excedrin and medication overuse can contribute to attacks.

The Heal Your Headache diet is based on his 30 years of experience with migraine patients, and although some don’t agree with it, enough people find it helpful to be worth reading.

Dr. Hain has some wonderful papers about vestibular disorders published on his site.

If you need extra help, The Dizzy Cook book has it all laid out for you easily! Endorsed by Dr. Buchholz, it is basically the patients perspective for implementing these changes into your life as easily as possible. 

The Dizzy Cook book cover

Migraine Diet Changes

Whether it’s keto, a migraine elimination diet, or a Mediterranean Diet it’s one of the easiest things you can start doing for yourself. If you have a lot of other restrictions due to allergies like dairy free, gluten free or if especially if you’re a strict vegan, consider enlisting the help of a registered dietitian to make sure you’re getting all the proper nutrients you need.

Food fears or being overly restrictive can easily lead to disordered eating, so try to pick one diet that works best for you and stick with it. If those are a factor, I highly recommend the Mediterranean migraine diet or having a dietitian familiar with high histamine/tyramine foods to help guide you.

Don’t pile everyone else’s opinions and restrictions on yourself. I’ve seen a lot of crazy opinions about diet, and I try to just stay in my lane of what works best for me. Dietary changes seem to be even more effective for people with a vestibular component. 

Mental Health

Going through something as difficult as dizziness and vertigo can make you feel completely out of control. Therapy can be a huge help. Look for a therapist that has had some experience helping patients with medical trauma, advocating for themselves, and working through the difficulties of living with an illness.

Cognitive behavioral therapy was helpful for me, but ACT therapy, EMDR (to process trauma), and talk therapy are all options. Dr. Emily Kostelnik has some great online programs, including our Vestibular 101 course with Dr. Madison (who discusses movement/ vestibular therapy).

Pain reprocessing therapy has been really popular in the chronic illness space recently. I have some friends who have amazing results, and others where it just helped a bit. For more on that you can visit Curable or Lin Health. The downside to some PRT programs is sometimes patients feel they are being taught to ignore or suppress symptoms, essentially gaslighting themselves.

But building neuroplasticity is essential for healing so finding what works best for you is so important. These are just options and all of us have different ways to heal.

Dr. Teixido also recommends the Feeling Good Handbook. Progressive muscle relaxation has also been very helpful for me as well as Insight Timer.

Support and Resources

Head to the Vestibular Disorders Association website. This will provide more information on types of vestibular disorders and treatment. Here you’ll also find links to support groups, some online, and many different educational resources.

A friend who is going through the same thing is invaluable. Often this can be done through private messaging someone you bond with in a support group.

When I saw Kayla’s story on VEDA I looked her up on instagram and sent her a message about us seeing the same doctor. We became instant friends since we were able to relate to everything, and eventually took our relationship to the phone.

That eventually grew into meeting each other in person. And now she comes over and lets me test out recipes on her while giving me advice on marketing.

Make sure you’re not confusing your support buddy for a therapist. If they’re also going through something similar, they may be able to only handle so much venting and sadness before it affects their own mental health.

Another important element is to choose the right vestibular disorder support group. Some are more positive than others, and joining them all can immerse you in a world of negativity where you’re scared to try anything new.

A few one-on-one support groups I like:

Remember that the majority of people in facebook groups are still haven’t found their perfect combo yet. Many, sadly, have given up. The ones who do get better often leave because positive experiences can be met with a lot of negative feedback in these groups.

So while it may seem like some people feel awful forever, that’s definitely not the case for everyone. I am proof of that (and I know many more as well!).

Give Yourself Time

This is unfortunately not something that will change overnight. It takes a lot of work and consistency. I personally didn’t have any improvement for months.

It took me over 2 full years to get to 100% days. I don’t say this to be discouraging, because for some people it does not take this long. But I also don’t want you to blame yourself if this doesn’t improve overnight. Too often I see people stop a supplement or diet one month in. Or they’ll give up on a medication just a week in.

All of things work together to help you raise your migraine threshold, and some of the side effects you may experience can also lessen over time.

Vestibular migraine is typically not a “take a pill and feel better the next day” kind of thing. If you’re concerned about a treatment you’re on, speak with your doctor first before stopping anything they have prescribed for you. It’s important to not compare your progress to someone else. 

My full vestibular migraine treatment plan.

Vestibular Migraine Posts

Shoutout to my friend and fellow VM warrior Megan Howard for her advice on this blog post! The post was updated 5.1.2020 to include new treatments and photos. It was updated again in 2024 to include new doctor information. 

Alicia

Alicia is a vestibular migraine advocate and the bestselling author of The Dizzy Cook: Managing Migraine with More Than 90 Comforting Recipes and Lifestyle Tips. Her articles and recipes have been featured by Healthline, Parade, mindbodygreen, Today, Good Morning Texas, the Vestibular Disorders Association, and the American Migraine Foundation. Read More

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40 Comments

  1. Terri says:

    First thank you for doing these articles they have helped so much! I am fortunate enough to have found an ENT who knows about Vestibular migraines. Right now we are seeing how much can be controlled with diet and supplements. I still have good and bad days but better overall. I’ve been curious if I should add a neurologist to my team as well? I’m in the Austin area

    Reply
    1. Alicia says:

      Absolutely. You can actually see my neurologist, Dr. Beh. I recommend driving to Dallas your first time to see him and then all your other appointments can be online. But you can also just see him online. It’s expensive, but he absolutely would be worth it for discussing medications. Then you could keep your ENT for local help. ENT’s can be great, I have a bunch I like to work with who focus more on VM (Not every ENT will do this), but they don’t have the same education in migraine meds and cannot perform treatments like nerve blocks/botox. So it really just depends on your severity and what kind of help you’re looking for.

      Reply