What are vestibular migraine triggers? Basically they're occurrences that either heighten existing symptoms, like going from background dizziness to vertigo, or start symptoms when you were previously feeling good.
My Journey with Vestibular Migraine
When my symptoms were 24/7, just 4 years ago, it seemed like everything was a vestibular migraine trigger for me. This time of year truly reminds me of how bad I was just a few years ago. I believe it was this month that I was rushed to the ER with a vertigo attack, convinced I had a brain tumor, only to be sent home with meclizine and a “good luck”.
As I finally received a diagnosis of vestibular migraine (and actually accepted it), I began my path to healing. Throughout this journey I’ve learned so many things, and my treatment plan has also changed over the years. I started off with medications that I’ve since weaned off of. I’ve re-introduced foods I once eliminated on a migraine diet. And my vestibular therapy went from specific exercises in a clinic, to taking HIIT classes and ballet on my own time.
My improvements certainly didn’t happen overnight, and neither did discovering exactly what my triggers were. In fact, some of them took me years to truly figure out and that was only after my brain had a chance to calm down with the combination of medications, diet, and supplements I was doing.
Still, there are a few common vestibular migraine triggers to watch out for that I see often in groups or that happen to me.
Top 10 Vestibular Migraine Triggers
Now these aren't the only triggers that exist, but they're some of the more common ones that I have personally experienced.
Big Box Stores and Fluorescent Lights
Not only are all the lights bright fluorescent and sometimes flickering (the worst!), but the rows mixed with different patterns of products can leave your vision feeling all kinds of wonky. Not to mention if it’s crowded with other people, it can be difficult to dodge them with your cart while keeping yourself up right.
In the past if someone bumped into me, it would totally throw me off my center of gravity. The one good thing was holding onto the shopping cart, which kept me stable and a little more centered.
One thing I hated the most was the "sticks" on the HOV lane in Dallas. As I passed by them in the car quickly, they created the most painful visual trigger. Sometimes the sun flickering through trees as we move in the car (or on a path) tends to bother me. Subway or train rides can give me vertigo if I watch the other trains pass in the opposite direction. Long flights or car rides tend to leave me feeling like I’m walking on marshmallows or still moving.
Some people with MDDS (Mal de Debarquement syndrome) actually find they feel better in motion, but most I talk to with vestibular migraine tend to be triggered by it. This could even apply to exercise. Certain exercises, like yoga with a lot of sun salutations, always made me more dizzy and increased the pressure in my head.
Do you feel as though you can predict the storm patterns if your area better than the weathermen? You’re not alone! Whenever storms are about to roll through, even sometimes a day before, my friend Kayla and I text each other. We can always tell when the weather is about to change. Often it’s worse during storms with lightening, but sometimes it can be from cold fronts or seasonal changes.
Another thing that gets me? Heat and humidity. There was even a study that showed low barometric pressure and higher temperature led to an increase in ER visits for migraine attacks.
Perhaps you’re not sleeping through the night and making up for it by napping during the day. Or maybe you’re sleeping in more and staying up late on weekends to try to switch back during the week. These changes in sleep schedule, although we often don’t think much of them, can trigger attacks for some people.
Even grinding of teeth could be triggering attacks if you are experiencing jaw pain in the mornings.
In my interview with Dr. Shin Beh, Vestibular Neurologist and founding Director of UT Southwestern’s Vestibular Neurology and Neuro-Visual Disorders Clinic, stress was the number one trigger he saw with his patients. Often many of us can pinpoint the start of our vestibular symptoms to a particularly stressful period in our lives. For me, mine was my former job.
But stress can be a part of everyday life, so it seems to be one of the most difficult vestibular migraine triggers to control.
From using hormonal birth control to spikes around ovulation and before or around our periods, women are prone to hormonal triggers throughout their lifetime. Pregnancy and menopause can either provide a welcomed relief or a spike in symptoms, but every woman is different. Some get relief from using birth control while others are triggered by it.
My neurologist and OB say for pregnancy, there’s a rule of threes. ⅓ of patients improve, ⅓ stay the same, and ⅓ have worsening of symptoms. Much of this can change after delivery. Managing of this particular trigger takes time and a good partnership with your neurologist and OBGYN. If this is a major trigger for you, don’t be afraid to ask your OB to coordinate with your neurologist to find the best treatment path for you. And look into some natural solutions you can try to ease these spikes.
Caffeine & Certain Foods
While caffeine can provide relief for some people with migraine, one study showed that for vestibular migraine specifically, quitting caffeine improved dizziness in 14% of patients as a solo treatment. When combined with nortriptyline, there was a 46% reduction in dizziness.
For me, it continues to be one of my biggest triggers. I can even tell if a coffee is just regular decaf versus a Swiss water processed decaf because I instantly get a fuzzy, floaty feeling in my head. While 14% isn’t a huge number, when you think about it being the only thing these participants changed, I think it’s enough to warrant a try.
While caffeine appears to be one of most common, it seems many with vestibular migraine are more sensitive to dietary triggers and can benefit from elimination diets. For me, a migraine diet and discovering my personal triggers was what pushed me to 100% symptom-free days.
This is one of the strangest triggers for me, but I find that if I’m holding long, focused conversations, especially when standing, the dizziness seems to creep in. I still can’t figure out if it’s the effort it takes to hold a conversation that is triggering or the focus on someone’s hand motions and moving mouth. Either way, I always found long conversations to spike my vestibular migraine symptoms. Anyone else?
When I was first diagnosed with vestibular migraine, I noticed that being out in warm, humid weather or post workout was when my symptoms would often appear. While it’s easy to blame the workout or the weather, often I think this was due to me not drinking enough water to begin with. Dehydration causes blood volume to decrease, resulting in less blood flow and oxygen to the brain. Some say a loss of electrolytes ignite symptoms as well.
It’s recommended that women drink about 9 cups a day and men 13 cups a day. This translates to about 72-104 ounces a day. I set a goal for myself to drink 4 of my S’well bottle a day back when I had constant symptoms, which is about 100 ounces total a day. With increased water intake, it may be helpful to add in some with electrolytes for every other bottle, like SmartWater (Trader Joe’s has a brand name one that’s less expensive). Or you can just supplement with adding it to your own water with LyteShow.
Scrolling and Screens
Scrolling on my iPhone was something I really struggled with in the beginning, and makes me think perhaps I should be doing more YouTube videos (although I found that movement triggering as well!). I often found myself reading online articles in bits at a time and I rarely went on Facebook or Instagram during that period of time.
A few things that do help are dimming my iPhone and computer screen and wearing migraine glasses, but limiting screen time can go a long way! Save articles you want to read and limit scrolling time as you can.
One thing to note is that some scrolling can be good, especially if you are greatly triggered by it. It’s similar to vestibular therapy, where your brain learns to accept the movement without causing dizziness. But just like vestibular therapy, it’s important to no over-do it.
Need to figure out how to manage these vestibular migraine triggers? Here are some posts that may help.
Vestibular Migraine Guide
Vestibular Migraine and the COVID Vaccine
Vestibular Migraine Prevention Diet
Acute Treatments for Vestibular Migraine
CBT - Cognitive Behavioral Therapy
Having a long conversation or following a presentation at work makes me feel off(dizzy). Thank you for letting us know we are not alone in this.
I get that one a lot! You're definitely not alone.
Lee Fowler says
I have recently been diagnosed with Vestibular migraines and I thought my symptoms were unique until I read this post. 2 months of feeling dizzy, having that floaty feeling. I noticed that chocolate is a trigger( all types) and coffee. I miss both. I didn’t realize that yogurt could be a trigger as well. Any suggestions to reduce the dizziness? My quality of life has been impacted, I no longer feel safe to drive any long distances, able to plan outings. I am dizzy everyday however the severity varies.
Hey Lee, I recommend reviewing the posts under the vestibular migraine tab and natural treatments. Also look into my first cookbook The Dizzy Cook and my youtube. Just tons and tons and tons of free info that will help reduce dizziness.
Mary Spray says
Yes. Long conversations are a trigger for me, too.
Conversations are a big trigger for me. I'm so happy to see this listed here because nobody seems to understand when I tell them this happens to me.
Of course! You're with people who understand here!
Could dairy be a trigger? I notice coffee isn’t alone but milk and creamer, pizza and smoothies with yogurt, migraine approved cheese on nachos, and butter in cookie dough usually give me an instant headache and dizzy symptoms. But I’ve just been putting it together as possibly dairy as a culprit.
So, dairy can be a trigger if you're sensitive to dairy in general, like an allergy. But overall, it's not a common trigger (and can be helpful for your brain too). But, a lot of the things you mentioned have a lot of fermented or aged dairy. Pizza usually has parmesan, yogurt is fermented, butter sometimes has "natural flavor" which can be hidden msg.
If you're noticing a sensitivity to even un-aged dairy like fresh mozzarella or soft goat cheese, or good quality butter like kerrygold, I would suspect a dairy sensitivity overall.
Standing still and having a conversation causes me to feel lightheaded. I feel like a chair that is missing one of its legs. I have to concentrate on standing because I get the feeling that I will fall over but I never do. Weird!
Long conversations trigger migraine for me. Until I read this article, I had never connected the migraines that resulted to being engaged in a long conversation. It is such a relief that someone else has had that experience as well.
Sandra Nash says
Long conversations is a biggie, lots of people or traffic going by, ceiling fans! Moving head left to right checking if it's safe to cross the road, getting off a moving car or bike after it stops. Endless list newbie diagnosed with v.m and waiting on lumbar puncture results for brain lesion
Long conversations have increased my vertigo at times. I believe it's because of the increased vibrations (caused by vocal cords being activated, sometimes because of holding the head and neck more strongly, or nodding/shaking the head while speaking, etc.) in the sinuses and elsewhere in the head.
Omg shaking my head to agree with people is a big trigger and if the person is swaying or using a lot of hand motions it’s the worst for my eyes. I always get a headache.
I was diagnosed with Migraine Associated Vertigo. I could not keep my eyes looking at a certain point. My gaze would slide down and I could not hold it.
For me it’s loud noises, bright lights, barometric pressure, too many colours or movements around me, leaning in a flower bed I can last 25 minutes maybe,
It saddens me that I have to ask my husband to tell me something later because I just cannot handle anymore. Exercises but I have found a Pilates chair helps. Long walks are out.
Have you tried migraine glasses? The ones with darker lenses? And VRT exercises might help some. I’ve noticed if I do yoga right before I go to bed (so if I get dizzy it doesn’t matter as much) it’s helped me to start walking again. I also have been going to grocery stores/target 3 times a week (can be suppper triggering) but that’s helped me to be able to get used to the lights/noise and colors and I’ve gone from only being able to walk a mile to 3 now. But I have axon glasses and I wear ear plugs at the store
I have all of those triggers, plus weird, fast cutting tv shows and strobing lights. Sound can get me too, loud, sudden or busy noisy environments. Daily VRT helps with the eye focus stuff, I’m much less susceptible as long as I do them.