Vestibular Migraines in Children

What are the signs and symptoms of a vestibular migraine?

Vestibular migraines can but don’t always involve migraine headache symptoms, such as:

• Severe, throbbing headache (usually on one side of the head)
• Nausea and vomiting
• Sensitivity to light, smell and noise

Vestibular migraine symptoms can also include:

• Vertigo (dizziness)
• Loss of balance
• Motion sensitivity or motion sickness
• Hearing issues such as ringing, fullness or pressure in one or both ears
• Sight issues such as blurred vision, sparkly auras, reduced peripheral vision, and/or distorted vision (objects may appear larger or smaller than they actually are)

What tests are used to diagnose a vestibular migraine?

There is no single test to diagnose a vestibular migraine. At Children’s Hospital Colorado, we’ve created the Pediatric Balance and Vestibular Disorders Clinic to help diagnose and treat conditions like vestibular migraines.

Our neurologists and audiologists work together for comprehensive neurologic and vestibular testing to rule out other causes of dizziness. Your child may also be evaluated by an otolaryngologist (ear, nose and throat doctor, or ENT), and we may recommend imaging tests.

It’s helpful to keep a journal of your child’s episodes including time and length of episodes, symptoms, and events that may have triggered an episode. These details can help us make a diagnosis.

We follow diagnostic criteria formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society and the Migraine Classification Subcommittee of the International Headache Society (IHS). The criteria to diagnose vestibular migraines are:

• At least 5 episodes with vestibular symptoms of moderate or severe intensity, lasting 5 minutes to 72 hours
• Current or previous history of migraine with or without aura (sensory disturbances) according to the International Classification of Headache Disorders (ICHD)
• At least 50% of vestibular episodes have one or more migraine features
• Headache with at least two of the following characteristics:
• One-sided location, pulsating quality
• Moderate or severe pain intensity, aggravation by routine physical activity
• Photophobia and phonophobia
• Visual aura
• Not better accounted for by another vestibular or ICHD diagnosis

What can I expect from vestibular migraine workup?

The first step is a vestibular evaluation, which may require a referral to Audiology Services from your child’s doctor. This evaluation varies depending on your child’s age and developmental level and will be scheduled for either 1.5 hours or 2.5 hours.

Depending on the evaluation results, your child may be referred to the Pediatric Balance and Vestibular Disorders Clinic for a multidisciplinary exam by doctors from Otolaryngology (ENT), Audiology, Physical Therapy and Neurology. If your child already has a managing neurologist, we may refer you back to that provider for vestibular migraine diagnosis and treatment instead of the balance and vestibular clinic.

How are vestibular migraines treated?

Treatment for vestibular migraines can vary from person to person and can include preventative or rescue medications prescribed by a neurologist and vestibular physical therapy. Additionally, vestibular migraines are often triggered by stress or anxiety, so sometimes mental health services and anxiety or depression medications are also recommended.

Children with vestibular migraines can reduce the number and intensity of migraines by:

• Avoiding triggers
• Eating whole nutritious foods rather than processed foods
• Exercising regularly
• Maintaining a regular sleep and meal schedule
• Managing stress and anxiety
• Staying hydrated throughout the day

Why choose us for treatment of vestibular migraines?

The Pediatric Balance and Vestibular Disorders Clinic at Children’s Colorado specializes in conditions like vestibular migraines in children. When children complain of imbalance or dizziness, it could be the result of many different conditions. Our dedicated clinic helps diagnose and treat the full range of conditions related to these signs and symptoms.

Children’s Colorado is the only center in the state that has an enclosed rotary chair, necessary for assessing vestibular disorders in children with developmental differences. Without this testing, it is difficult to completely rule out inner ear disorders in some children.

The American Migraine Foundation provides education, support and resources for the millions of men, women and children living with migraines, including vestibular migraines.

Contacting us and making an appointment

Talk to your child’s doctor or neurologist about your concerns. We usually require a referral to both audiology and ENT departments by a physician or advanced practice provider for vestibular testing and diagnostic exams.

We also want to ensure that the symptoms your child is experiencing do not require urgent medical attention. You can discuss these symptoms with an ENT nurse and get advice by calling 720-777-8501.

Most of the time, we recommend vestibular testing to gather more information. If a vestibular evaluation is recommended, a scheduler will contact you to set up an appointment and provide additional instructions on how to prepare for the evaluation.