Migraine - Dizziness-Doctor.com

For patients

Migraine is very common

Migraine is a very common disease, estimated by some studies to affect as much as 10% of the general population. It is sometimes difficult to diagnose migraine because it can have a wide variety of symptoms (Buchholz and Reich 1996).

Migraine is poorly understood

The underlying pathophysiology of migraine remains incompletely understood despite considerable research efforts. Some of the proposed explanations include abnormal electrical activity in the brain, abnormal constriction of the cerebral blood vessels, and abnormal reactivity of those parts of the brainstem that process sensation from the face and head (Dodick and Gargus 2008). The fact that migraine is poorly understood has made it difficult to come up with good treatments.

Migraine is often misdiagnosed because it can masquerade as other diseases

Often patients do not receive appropriate medical treatment because they do not recognize that they have migraines (Cady and Schreiber 2002, Kaniecki 2002, Schreiber, Hutchinson et al. 2004). As an example, a survey of several thousand people reported the startling statistic that 46.6% of patients who met the criteria for migraine actually thought that they had some other kind of headache. The most common erroneous self-diagnoses were “sinus headaches” or “tension headaches” (Lipton, Stewart et al. 2002).

Migraine can manifest with non-pain symptoms

A common misperception of migraine is that it is just a “really bad headache.” While it is true that many people with migraines find the headache to be the most incapacitating aspect of their symptoms, it is very important to understand that migraine often involves non-pain symptoms. These non-pain symptoms are quite variable, and can include things such as visual changes, numbness or tingling, weakness of part of the body, incoordination, language impairment, cognitive changes, and even alterations in consciousness. One of the most common non-pain symptoms of migraine is disequilibrium in its various forms, such as unsteadiness, dizziness, lightheadedness, or vertigo (Kuritzky, Ziegler et al. 1981, Kayan and Hood 1984, Cutrer and Baloh 1992, Johnson 1998). Sometimes dizziness can be the only manifestation of migraine (Harker and Rassekh 1988, Lee, Lopez et al. 2000, Cherchi and Hain 2011, Cherchi and Hain 2013). Migraine can also involve auditory abnormalities such as hearing loss (Viirre and Baloh 1996) and tinnitus (Bayazit, Yilmaz et al. 2001, Volcy, Sheftell et al. 2005, Kirchmann, Thomsen et al. 2006).

Migraine is the most common brain-related cause of dizziness

Unsteadiness can be caused by problems in a variety of body systems, including the ears, eyes, neck, joints, muscles, cardiovascular system, and peripheral nerves. Unsteadiness can also result from brain problems, and when this is the case, the cause is usually migraine (von Brevern, Zeise et al. 2005). There is substantial literature about migraine associated vertigo (Dieterich and Brandt 1999, Neuhauser, Leopold et al. 2001, Neuhauser, Radtke et al. 2006, Neuhauser and Lempert 2009, Cherchi and Hain 2011, Cherchi and Hain 2014, Hain and Cherchi 2018, Beh, Masrour et al. 2019, Hain and Cherchi 2019, Abouzari, Goshtasbi et al. 2020, Huang, Wang et al. 2020).

The pain and non-pain parts of migraine can behave independently

Migraine is sometimes difficult to recognize because the pain part (the headache) and the non-pain part (whether it is dizziness, visual changes, weakness, etc.) do not necessarily occur simultaneously. In fact, the pain and the non-pain parts of migraine can follow completely separate schedules (Bisdorff 2004). Sometimes the non-pain parts of migraine have a rather chronic nature, and can even go on for several months, totally independent of actual headaches (Waterston 2004).

Migraine can occur even without headache

Though rare, some people have migraines that rarely or never involve headaches. In other words, their migraines only have non-pain symptoms. You may have heard of so-called “ocular migraines,” and this is one example of a migraine that only has only non-pain symptoms (namely, visual symptoms) and no headache whatsoever. But any of the other non-pain symptoms mentioned above can also be the sole manifestation of migraine (Amos and Fleming 2000, Freedom and Jay 2003).

Migraine characteristics can change over one’s life

The symptoms of migraine can change over the course of one’s life, and this is probably one of the features that make it difficult to recognize. Migraines can come and go; they can change in intensity, frequency or duration; and their non-pain characteristics can also change (Bigal, Liberman et al. 2006, Kelman 2006).

Migraine patterns are sometimes associated with hormonal fluctuations

It is fairly common for migraine patterns to coincide with other physiologic changes. A common example is that migraine can be affected by hormonal changes such as those that occur during the menstrual cycle (Brandes 2006).

Migraine often occurs in association with other diseases

Migraine seems to occur in association with certain other diseases more frequently than would be expected by chance. For instance, migraine is found with greater than average frequency in people with thyroid problems, benign paroxysmal positional vertigo, seizures, Ménière’s disease, and mal de debarquement syndrome. This does not mean that they are the same disease. The reasons for these associations are not clear.

Migraine patients usually have normal neurological examinations

If a person with migraines has no other medical problems, then his or her physical examination is usually normal. One exception to this is that people with migraines sometimes have subtle abnormal eye movements which we can observe in clinic using infrared video Frenzel goggles (Kayan and Hood 1984, von Brevern, Zeise et al. 2005). Sometimes migraine patients also have eye movement abnormalities that can be detected by a test we use in the clinic called electronystagmography (Szirmai 1997).

There are no good tests for migraine

We diagnose migraine primarily based on the patient’s description of the symptoms. We rely on this because there is no blood test for migraine, and for the most part there is no imaging study that detects migraine. Some studies (Swartz and Kern 2004; Zhang et al. 2023) — though not all (Niu et al. 2025) — report that a small percentage of migraine patients will have subtle abnormalities on brain MRI; however, those abnormalities can also occur in certain other diseases (Liu et al. 2013), so the mere presence of the abnormalities does not make the diagnosis of migraine definitive. These MRI abnormalities, if present in a migraine patient, do not seem to progress over time (Hamedani, Rose et al. 2013). Other diagnostics, such the detection by high resolution MRI of subtle changes in the thickness of the somatosensory cortex (DaSilva, Granziera et al. 2007, Schwedt, Chong et al. 2015) temporal cortex (Schwedt, Berisha et al. 2015) and other areas (Magon, May et al. 2018), the detection by functional MRI of abnormal activity in vestibular nuclei and vestibular cortex (Tedeschi, Russo et al. 2015) and other sensory areas (Schwedt, Chiang et al. 2015), the detection by functional MRI of abnormal levels of gamma amino butyric acid in the occipital cortex (Bigal, Hetherington et al. 2008), the detection of decreased levels of circulating progenitor endothelial cells (Lee, Chu et al. 2008), are still exploratory and restricted to research settings.

Keeping a diary may help make the diagnosis and identify triggers

Since the diagnosis of migraine relies on the patient’s description of the symptoms, it is often helpful if a patient keeps a diary. The diary should include a detailed log of the particular symptoms, including when they start, when they end, how intense they are, and whether a particular episode has any unusual characteristics. It is also helpful to include in the diary things such as foods eaten, activities, and sleep schedules, because sometimes a pattern emerges which helps identify potential triggers for migraines (Tepper, Dahlof et al. 2004).

Migraine must be distinguished from other types of headaches

As discussed earlier, migraine can have a broad range of symptoms. This can make it difficult to distinguish from other diseases, including other types of headaches, particularly since the International Classification of Headache Disorders identified 184 distinct types of headache under 14 major headings (2004). Your doctor will work with you in trying to determine whether your symptoms might be related to migraine.