Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is a commonly diagnosed cause of vertigo and dizziness on the Gold Coast, accounting for up to 42% of all vertigo diagnoses. Symptoms involve bouts of dizziness that are caused by head movements. Attacks are often very intense, causing BPPV to become a very debilitating condition for most sufferers.
BPPV is easily diagnosed with physical testing and a history taken by your health professional, scans are very rarely required. The physical tests will assess structures in your inner ear called cannula, which are known to be the cause of BPPV.
Many of the patients that we see at Gold Coast Headache & Migraine Clinic™ have all of the symptoms of BPPV, but do not respond to treatment or the physical testing cannot accurately diagnose them.
Hypertension Headache
Hyper-tension, or high blood pressure, has been reported to affect up to 45% of the Gold Coast Population. This rate is much higher in the older age-groups, with the prevalence increasing each decade of life. Headache has historically been a reported symptom of hyper-tension, with GPs regularly analysing headache symptoms as a way to monitor progression.
Despite this, the link between hyper-tension and headache is not clear, and research hasn’t been able to determine the root cause of hyper-tension headaches. Modern headache research suggests that sensitivities in the brainstem may be the true cause of hyper-tension headaches. It is essential that you are appropriately assessed to find the right vestibular migraine treatment for your hypertension headaches.
Vertigo Cervical Headache
While the most commonly diagnosed cause of vertigo is BPPV, when treatment for this is ineffective or assessment is unclear Vertigo Cervical Headaches are a likely diagnosis. Patients describe episodes of dizziness or vertigo, as well as more classic signs of headache or migraine.
Patients with migraine associated vertigo attacks will often describe stiffness in their neck, and this is often associated with more severe symptoms. It is often reported that attacks can be triggered by visual changes, like; flickering lights, bright lights or visual disturbances.
Understanding Vestibular Migraines & Their Triggers
Vestibular migraines are a type of migraine disorder that affects the vestibular system, responsible for balance, spatial awareness, and coordination. Unlike standard migraines, which are often associated with head pain, vestibular migraines primarily cause dizziness, vertigo, and balance dysfunction.
Common Triggers of Vestibular Migraine Attacks
Vestibular migraine episodes can be triggered by various factors, including:
- Sensory Overload – Bright lights, loud noises, or crowded environments
- Rapid Head Movements – Sudden changes in position, such as standing up too quickly
- Motion Sensitivity – Travel-related motion sickness from cars, boats, or aeroplanes
- Hormonal Changes – Fluctuations in estrogen, particularly in women
- Stress & Fatigue – Poor sleep and high-stress levels can increase migraine frequency
- Dietary Triggers – Aged cheese, caffeine, alcohol, and processed foods may trigger migraines in some individuals
Identifying your unique triggers can help in developing a migraine and vertigo treatment plan that reduces the frequency and severity of vestibular migraine attacks.
How are Vestibular Migraines Diagnosed?
To diagnose vestibular migraines, healthcare professionals explore symptoms related to migraine headaches, such as a throbbing headache, along with those linked to vestibular disorders, such as vertigo and dizziness. This process involves a thorough medical history and physical examination, focusing on the interplay between migraine headache symptoms and vestibular symptoms like balance issues. Diagnosis hinges on meeting specific criteria outlined for vestibular migraine diagnosis, which considers both migraine-related dizziness and classic migraine headache symptoms.
Exclusion of other potential causes, including inner ear disorders and neurological conditions, is paramount to confirm vestibular migraines. Diagnostic tests like vestibular function assessments and imaging studies may be employed for this purpose.
Diagnostic Criteria for Vestibular Migraine
To correctly diagnose a vestibular migraine, a patient must meet the International Classification of Headache Disorders (ICHD-3) diagnostic criteria, which includes:
- At least five episodes with moderate or severe vestibular symptoms, lasting between 5 minutes and 72 hours
- A current or past history of migraines (with or without aura)
- At least 50% of episodes must include one or more migraine features, such as:
- Headache with at least two of the following:
- One-sided location
- Pulsating quality
- Moderate or severe intensity
- Worsens with routine physical activity
- Photophobia and phonophobia
- Visual aura
- Symptoms cannot be better explained by another vestibular or neurological disorder
Because vestibular migraine symptoms can vary from person to person, an accurate diagnosis requires a detailed assessment of migraine history, vestibular symptoms, and potential triggers.
What causes vertigo?
Vertigo is a symptom, not a diagnosis, describing a false sensation of spinning or movement when you are stationary. It is most commonly related to changes within the inner ear (vestibular system), but may also involve neurological and sensory processing pathways that contribute to balance and spatial awareness.
Common causes include:
- Benign paroxysmal positional vertigo (BPPV)
- Vestibular neuritis
- Labyrinthitis
- Vestibular migraine
In many cases, vertigo is multifactorial, involving overlap between vestibular function, neurological sensitivity, and how the brain processes balance information.
How long can vertigo last?
Duration depends on the underlying cause. BPPV episodes are typically brief, often lasting seconds to minutes and triggered by certain head movements.
Other conditions present differently:
- Vestibular neuritis may cause more prolonged dizziness lasting days to weeks
- Vestibular migraine can vary from short episodes to longer periods of imbalance or disequilibrium
Some people also experience a lingering sense of unsteadiness between episodes, even when the spinning sensation has settled.
How can vestibular migraine and vertigo be managed?
Management generally focuses on reducing symptom triggers and supporting the balance system’s ability to recalibrate over time.
Vestibular rehabilitation exercises may be used to improve tolerance to movement and help retrain balance pathways. Lifestyle factors such as sleep regularity, hydration, stress load, and identifying individual triggers can also play an important role.
In more persistent or complex presentations, clinicians may also assess whether cervical musculoskeletal input is contributing to overall sensory processing and symptom sensitivity. Where migraine features are present, the Watson Headache Approach may be considered as part of a broader clinical assessment.
What are vertigo symptoms and treatment?
Vertigo commonly presents as a spinning or movement sensation, often accompanied by dizziness, nausea, imbalance, and sensitivity to head position changes. Symptoms may be triggered by simple movements such as turning in bed, bending forward, or looking up.
Treatment depends on the underlying cause. For BPPV, specific repositioning manoeuvres performed by a trained clinician can often reduce symptoms effectively. Other causes, such as vestibular migraine, may require a combination of medical management and vestibular rehabilitation to help reduce frequency and severity over time.
Clinicians at Gold Coast Headache & Migraine Clinic™ consider possible contributing factors to help guide clinical management, including vestibular, neurological, and cervical influences where clinically relevant.
