Published December 25, 2016, Authored by Dr. Adam Lowenstein

Dizziness icon cartoon. Single sick icon from the big ill, disease collection.Dizziness is often a symptom of migraines and occipital neuralgia, and can be seen both with and without associated pain.  Because balance and dizziness are managed by a region of the inner ear called the vestibule, migraines that manifest in dizziness alone are termed “vestibular migraines”.  Similar to “ocular migraines”, these episodes can manifest as periods of corresponding discomfort triggered in the same way as a classic migraine is.

Since dizziness is a frequent symptom of migraines and occipital neuralgia, it seems as though there is an intimate association between the pathology that causes pain and the pathology which causes associated symptoms such as dizziness, blurred vision, and nausea.  When non-pain symptoms occur alone, on a regular basis, and have a significant impact on your lifestyle, they meet enough criteria to be seen as “migraine” even though they don’t have associated pain.

If you experience non-pain symptoms of migraine associated with triggers known to cause classic migraines, various treatments may help.  While poorly understood, it does seem that peripheral nerve compression such as that causing migraine pain can cause non-pain symptoms and be relieved by nerve decompression.

Let me share my personal experience…. I have had migraine pain for more years than I can count, and often have episodes of dizziness and nausea associated with my own migraine headaches.  This last summer, recently I began to have daily (yes, daily) episodes of momentary dizziness and sometimes sustained dizziness without the pain of my usual headaches.  I spoke to my personal  general practitioner about it (yes, even I follow my own advice and check things with my doctor to confirm my own suspicions).  My physician is a very smart guy though he knew that I was pretty stressed raising my 4 and 2 year old while managing a busy practice- he suggested it was stress related.  While he was likely partially correct, it did seem that my migraine headache medication made things better and so I treated myself appropriately.

In addition to taking my Zomig which works well for me, I had a colleague inject Botox into the muscles around my greater occipital nerve, lesser occipital nerve, and third occipital nerve during a recent plastic surgery meeting (see those nerves here).  The results were as expected but amazing- complete alleviation of both my dizziness as well as my migraine pain for the next 6 weeks.  I had proved to myself that even I was a great candidate for the treatment I provide my patients.  The muscular compression and constriction around my occipital nerves was causing not only my migraine pain, but also my “vestibular migraine” and dizziness that I experienced with and without my pain.

So what is my next step?  Finding some time to have migraine headache surgery myself!  That is not likely to be too soon with my practice and family obligations as they are, and I’m lucky that I have a great response to Zomig to alleviate my symptoms medically when I need to.  But if I was a patient who walked into my office with my story…. dizziness both with and without pain associated with migraine patterns and triggers, I would feel pretty confident telling me that I was an excellent candidate for nerve decompression migraine surgery for my occipital neuralgia.  (I hope that grammar doesn’t make you dizzy 🙂 )


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