Dizziness and Migraines at the Same Time — Could It Be Vestibular Migraine?
You’ve been managing dizziness and migraines for years. Has anyone told you they might be the same condition?
Most working professionals who come to us with both dizziness and migraines have been managing them as two completely separate conditions. Two sets of appointments. Two sets of strategies. Two conditions that improve partially — and never fully resolve.
The neurologist manages the migraines. The ENT rules out the serious structural causes. The GP manages the dizziness with vestibular exercises. And somewhere in the middle, the person living with both is passed between specialists without anyone ever saying the words that would change everything:
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These might not be two conditions. They might be one. |
What is vestibular migraine — and why haven’t I heard of it?
Most people picture migraine as a headache. It is not always.
Migraine is a neurological condition — one that affects how the brain processes sensory information. And it targets multiple systems, not just pain pathways. One of its primary targets is the vestibular system: the inner ear and brainstem network that governs balance, spatial orientation, and the brain’s ability to process movement accurately.
In vestibular migraine, the vestibular system becomes a site of migraine activity. The result is dizziness, vertigo, and balance problems — not alongside the migraine as a separate condition, but as the migraine itself.
You may have vestibular migraine without ever experiencing a classic headache. You may have vertigo episodes that last minutes, hours, or days. You may have dizziness that worsens under professional pressure without any accompanying pain. Or you may have the dizziness and the headache simultaneously — but assumed, because everyone around you has too, that they were coincidental.
They are not coincidental. They are the same neurological process expressing itself across two systems that happen to be assessed by different specialists.
What does vestibular migraine actually feel like at work?
This is the part most medical descriptions miss — what vestibular migraine looks like inside a demanding professional life.
The morning commute.
The tube is difficult. Crowded, visually complex, constantly moving. You have started choosing seats that face forward, standing near the doors, sometimes driving instead — and you have explained this to yourself as a preference rather than a symptom.
The open plan office.
Fluorescent lighting. Multiple people moving simultaneously. Background noise that other people seem to filter without effort. By mid-morning on a demanding day, the effort of processing the environment is already adding to the cognitive load the job is generating.
The afternoon build.
Not always a headache — sometimes just a heaviness behind the eyes, a slight unsteadiness that nobody else notices, a fog that makes the screen harder to process than it should be. You have turned the brightness down. You have rescheduled the meeting that didn’t need to happen today.
The stress correlation.
Demanding weeks are worse. Deadlines, difficult conversations, sustained cognitive output — all of it amplifies the symptoms in ways that purely vestibular conditions don’t always explain. The pattern is so reliable you have started predicting when the bad days will arrive. You just haven’t had a clinical name for why.
The holiday effect.
Within a day or two of genuine rest, the dizziness eases. The brain fog lifts. You feel, for a brief period, like yourself. And then the week before returning to work, it starts to build again — before you have done anything physically demanding.
This is the stress-symptom relationship that defines vestibular migraine in working professionals. And it is the piece of the picture most treatment never addresses.
Why does it always get worse when work gets demanding?
Vestibular migraine is acutely sensitive to nervous system load.
The migraine brain has a lower threshold for processing sensory input than a non-migraine brain. When the nervous system is well regulated — during genuine rest, during holiday, during periods of lower demand — that threshold holds. Symptoms are manageable or absent.
When the nervous system is under sustained professional pressure — absorbing the demands of a high-performance career, managing the invisible load of unpredictable symptoms alongside professional expectations, running on disrupted sleep and sustained cognitive overload — the threshold drops. Every incoming sensory signal is amplified. The migraine activity increases. The vestibular symptoms worsen.
This is not a psychological response to stress. It is a neurophysiological one.
The nervous system is the amplifier. And in working professionals with vestibular migraine, it has often been running at sustained high alert for far longer than they realise — not just during the bad weeks, but as a baseline state that the body has learned to accept as normal.
This is also why treating the vestibular system and the migraine pathway alone produces incomplete results. If the nervous system amplifying both is not addressed simultaneously, treatment is working against a constantly active maintaining factor.
Why hasn’t my treatment fully resolved it?
This is the most common question we hear from vestibular migraine patients — and it almost always comes with a particular kind of exhaustion attached.
The medication plateau.
Migraine medication addresses the acute headache pathway. It does not address the vestibular system that has been sensitised by repeated migraine activity, the cervical spine feeding into both systems simultaneously, or the nervous system amplifying every signal they produce. The headaches may reduce. The dizziness remains.
The VRT plateau.
Vestibular rehabilitation retrains the balance system. It does not regulate the nervous system that is amplifying every vestibular signal — or address the migraine activity that is generating new sensitisation alongside the rehabilitation. Progress is made and then stops. The same ceiling. Every time.
The cervical spine dimension.
In almost every vestibular migraine patient Alessio assesses, the upper cervical spine is a significant contributing factor that has never been properly evaluated. C1–C2 restriction, elevated first ribs, suboccipital muscle tension — all of these have direct neurological connections to both the vestibular system and the migraine pathway. Releasing them produces measurable symptom reduction that neither medication nor vestibular exercises can produce.
The missed diagnosis itself.
When the neurologist and the vestibular physiotherapist are working separately, both are working with incomplete information. Neither has the full clinical picture. And the patient, having seen both, feels they have tried everything — when in fact the two pieces have never been assessed as one.
What does treating vestibular migraine properly look like?
At Hito Holistic Health, we treat vestibular migraine through a structured 12-week programme — the Hito Method — working across three dimensions simultaneously.
The body.
Alessio’s initial session covers the vestibular system, the upper cervical spine, the visual-vestibular integration, and the cranial structures — assessment and hands-on treatment in the same 60-minute appointment. Treatment integrates myofascial induction therapy, craniosacral therapy, Mulligan mobilisations, PNF neck work, and acupuncture. Progressive VR vestibular rehabilitation is used to recalibrate the vestibular system’s processing with precisely calibrated challenge that increases as tolerance builds. We are one of very few clinics in London offering this as part of a structured vestibular migraine programme.
The nervous system.
Julie builds the regulatory capacity that raises the threshold at which both vestibular and migraine symptoms are triggered. Breathwork and regulation techniques specifically calibrated for the professional who cannot and will not slow down — because the goal is not a quieter life. It is a nervous system with enough capacity to hold the demanding life you already have without treating every stressful week as a threat signal.
The mindset.
Coaching and psychoeducation to address the push-through patterns and the avoidance patterns that sustain nervous system dysregulation — often both present simultaneously in vestibular migraine patients. The professional who keeps delivering despite symptoms. The social life quietly shrinking around the triggers. Both sustain the sensitisation. Both are specifically addressed.
What do patients experience — and when?
The pattern we see consistently across our vestibular migraine patients — people who came to us after years of managing dizziness and migraines separately without either fully resolving — looks like this:
By weeks 3–4, brain fog lifts.
For most vestibular migraine patients this is the first shift they notice — not the dizziness or the headaches, but the cognitive heaviness that makes the working day feel so much harder than it should. It begins to clear.
By weeks 6–8, migraine frequency is reducing meaningfully.
The attacks that were weekly become less frequent. The ones that do arrive are less severe. Patients begin to understand their stress-symptom relationship with real clarity — and for the first time, have tools to interrupt it.
By weeks 8–10, dizziness has shifted from constant to triggered.
That transition — from something always present to something that comes and goes — changes daily life significantly. The low-level vigilance that was exhausting in itself begins to ease.
By weeks 10–12, migraines are near-eliminated or resolved entirely.
Trigger maps that arrived as long unclear lists have simplified dramatically — patients who came in with multiple unpredictable triggers leave with one or two clearly identified factors. Breathwork is embedded as a daily proactive tool, used at stress onset rather than reactively during episodes.
By programme exit, patients return to the activities vestibular migraine had quietly taken from them.
Exercise, sport, travel, and the full working week without the constant background calculation of how symptomatic today might be.
The data behind this:
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Across our vestibular migraine patients, ~92% average reduction in migraine severity at 8 weeks. 100% of completers achieved elimination or near-elimination of migraines by programme exit. Brain fog resolved or significantly reduced in 100% of vestibular completers. Dizziness significantly reduced by week 8–10 across the vestibular cohort. 100% of migraine patients understood the nervous system drivers of their condition for the first time. |
The consistent clinical observation across both cohorts: improvement had stalled before Hito because the dizziness was being treated by one specialist and the migraines by another — and the nervous system amplifying both was never addressed at all. When all three dimensions are treated simultaneously, the outcomes are different. Not because the treatment is more aggressive — because it is finally complete.
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“Sustained vestibular recovery requires more than exercises alone. The body work creates the foundation. The nervous system work creates the outcome that lasts.” — Alessio Barone, Specialist Physiotherapist & Co-Director, Hito Holistic Health |
If this sounds like your experience — what next?
If you have been managing dizziness and migraines separately for months or years, and neither has fully resolved, a free 30-minute clarity call with our team is the right starting point.
Not a sales call. Not a commitment to anything. A clear, unhurried conversation about what is driving your symptoms specifically, whether the Hito Programme is the right fit, and what the first steps would look like for your situation.
We work with working professionals in London who have tried the standard routes and reached the ceiling of what single-dimension treatment can produce. If that is where you are — this is the conversation worth having.