Vestibular migraine is one of the most common causes of recurring dizziness and vertigo in adults, yet it often goes undiagnosed for years because the headache is not always the most prominent symptom. For many people, the dizziness and the visual symptoms come first, and the headache is mild or even absent.
If you have episodes of dizziness, balance problems, or a feeling that your surroundings are moving, combined with sensitivity to light or motion, it is worth understanding the visual dimension of what is happening.
What vestibular migraine is
Vestibular migraine is a subtype of migraine in which vestibular symptoms, affecting balance and spatial orientation, are a prominent feature. During an episode, a person may experience vertigo (a sensation of spinning), unsteadiness, a feeling of rocking or floating, nausea, and sensitivity to head movement.
The vestibular symptoms are caused by the same underlying brain mechanism as conventional migraine: spreading waves of electrical and chemical changes that temporarily disrupt the function of neural networks, in this case those governing balance and spatial orientation as well as pain.
Visual symptoms in vestibular migraine
Visual symptoms are very common in vestibular migraine and may include:
- Photophobia: Sensitivity to light, often severe, that persists between attacks in some patients.
- Visual snow: A persistent visual disturbance in which the visual field appears to contain static or snow, similar to an out-of-signal television. This is associated with migraine and is thought to reflect abnormal activity in visual processing areas of the brain.
- Visual aura: Zigzag lines, shimmering arcs, or blank spots in the visual field that typically last 20 to 60 minutes. These are caused by a wave of neurological activity spreading across the visual cortex.
- Motion sensitivity: Environments with a lot of visual movement (busy shopping centres, scrolling screens, passing traffic) can trigger or worsen episodes, because the visual system is feeding conflicting motion signals to the already-sensitised vestibular system.
- Blurred vision: Transient blur during or around an attack, not caused by a change in prescription but by the disruption of normal visual processing.
What an optometrist can do
Vestibular migraine is primarily managed by a neurologist or GP, but there is a clear role for optometry. An eye examination in a patient with vestibular migraine aims to:
- Exclude any eye-based cause for the visual symptoms (retinal issues, binocular vision problems, or prescription changes that may be compounding the symptoms)
- Assess for and manage light sensitivity, including providing FL-41 tinted lenses where appropriate
- Check binocular vision function, which can be disrupted in vestibular migraine and contribute to the feeling of visual instability
- Provide documentation for your neurologist or GP regarding your visual function
FL-41 glasses for vestibular migraine
Light sensitivity and visually cluttered environments are two of the most frequently reported triggers for vestibular migraine episodes. FL-41 tinted lenses reduce the blue-green wavelength load that activates migraine-related pain pathways, which can lower the overall trigger burden and reduce episode frequency for some patients.
At Prime Optometrists Auburn, we stock FL-41 lenses and can discuss whether they are appropriate for your specific presentation. We welcome patients from Auburn, Berala, Lidcombe, Granville, Parramatta, Merrylands, Guildford, Strathfield, Burwood, Concord, Homebush, Campsie, and across Western Sydney. Book online or call (02) 9761 0005.