Silent Vestibular Migraine: Dizziness and Vertigo Without the Headache

Posted on14 August 2026,in

By Dr. Rusty Lavender — Lavender Family Chiropractic, Sarasota, FL

If you have episodes of spinning, swaying, rocking, or a strange sense that the floor is moving under you — and yet your head does not hurt at all — you may have spent months or even years wondering what is wrong. You have likely been told a dozen different things: it is your inner ear, it is your neck, it is anxiety, it is dehydration, it is stress, it is nothing to worry about. Meanwhile the dizziness keeps coming back, sometimes lasting minutes, sometimes hours, sometimes leaving you exhausted for a full day afterward.

There is a name for a common cause of exactly this pattern, and it surprises many people: vestibular migraine. And there is an even more confusing version of it that this article is about — the “silent” or headache-free form, sometimes called acephalgic vestibular migraine. It is migraine biology expressing itself as dizziness and vertigo instead of head pain.

This article is written to help you understand what silent vestibular migraine is, why it gets missed so often, and how it is properly diagnosed. I also want to be honest and clear about where our practice fits in. I am an upper cervical chiropractor, and I care for many people in Sarasota who live with dizziness. Vestibular migraine is a neurological migraine disorder. There is no evidence that upper cervical chiropractic treats, cures, or prevents it. What I can do is help you sort out whether a separate neck-related balance factor is part of your picture, and coordinate that with the neurological and vestibular care you deserve. Let me walk you through all of it.

What Is Vestibular Migraine?

Migraine is not simply “a bad headache.” It is an inherited disorder of how the brain processes sensory information. In a migraine brain, the systems that handle light, sound, motion, smell, pain, and balance are more excitable and more easily overwhelmed than average. Most people picture migraine as throbbing head pain with nausea and light sensitivity, and for many that is exactly how it shows up. But the same underlying biology can drive other symptoms, and one of the most common is dizziness.

Vestibular migraine (VM) is the term for migraine that produces vestibular symptoms — vertigo (a false sense of spinning or motion), unsteadiness, sensitivity to motion, and a feeling of being pulled or rocked. The vestibular system includes the balance organs of the inner ear and the many brain pathways that interpret their signals. When migraine physiology involves those pathways, the result is dizziness rather than, or in addition to, head pain.

Vestibular migraine is now recognized as one of the most common causes of recurrent spontaneous vertigo in adults. It affects people across the lifespan, is more common in women, and frequently runs in families alongside more typical migraine. Many people with VM have a personal history of classic migraines earlier in life — often in their teens and twenties — that faded or changed character as they got older, only to be replaced by episodes of dizziness in midlife.

The Key Idea: Migraine Can Attack Balance Instead of Causing Pain

Here is the concept that unlocks everything else in this article. In migraine, head pain is only one possible symptom, not a requirement. The brain’s migraine machinery can generate an “attack” that features dizziness prominently and head pain minimally or not at all. When that happens, the person having the attack does not think “migraine,” because there is no headache to point to. And often, neither does the clinician they see.

This is why vestibular migraine is one of the most under-recognized conditions in medicine. The symptom that would make everyone think of migraine — the headache — is exactly the symptom that may be missing.

Silent (Acephalgic) Vestibular Migraine: Dizziness Without the Headache

The word “acephalgic” simply means “without head pain.” Silent or acephalgic vestibular migraine describes attacks in which vestibular symptoms occur but headache is absent or so mild that the person does not notice or report it.

Two important truths often surprise people:

First, headache is frequently absent during vestibular migraine attacks. Many people assume that if it were migraine, their head would hurt. In reality, a large share of vestibular migraine episodes involve little or no head pain. The vertigo and the headache do not have to occur together, and in many people they occur at completely separate times, or the headache stops happening altogether while the dizziness continues for years.

Second, you can still be diagnosed with vestibular migraine even during a stretch of life when you never get headaches — provided you have a documented history of migraine at some point. Diagnostic frameworks account for this precisely because acephalgic attacks are so common. The migraine history is the anchor; the current dizziness is the presentation.

What a Silent Vestibular Migraine Attack Can Feel Like

No two people describe their attacks identically, but common features include:

A sense that the room is spinning (true vertigo), or that you yourself are spinning or tilting
A rocking, swaying, or “boat on water” sensation, even while sitting still
Feeling pulled to one side, or as if the floor is rising or dropping
Motion sensitivity — busy visual environments, scrolling screens, grocery store aisles, traffic, or being a passenger in a car can trigger or worsen symptoms
Sensitivity to light or sound during the episode, even without pain
Nausea, sometimes with vomiting
A feeling of pressure or fullness in the head or ears without actual pain
Difficulty concentrating, a “foggy” feeling, or exhaustion afterward
Attacks that last anywhere from a few minutes to several hours, occasionally up to a day or two

Some people have brief, intense spinning episodes. Others have a background of near-constant unsteadiness with flares. Both patterns can belong to vestibular migraine.

Why “Silent” Does Not Mean “Minor”

Do not let the word “silent” fool you. Headache-free does not mean symptom-free or low-impact. Vestibular migraine can be profoundly disruptive. People rearrange their lives around it — avoiding driving, declining social invitations, struggling at work, feeling unsafe on stairs or in open spaces. The unpredictability is its own burden: you never quite know when the next wave will hit. The absence of pain does not lessen the disability; it often just delays the correct diagnosis.

Why Silent Vestibular Migraine Gets Missed So Often

Understanding why this condition slips through the cracks can save you a great deal of frustration and self-doubt.

1. The Missing Headache Removes the Obvious Clue

Clinicians are trained to associate migraine with headache. When a patient reports dizziness and specifically says “but my head doesn’t hurt,” migraine may be dismissed early in the thought process. The most recognizable feature of the disorder is simply not there to be recognized.

2. The Symptoms Overlap With Many Other Conditions

Dizziness is one of the least specific symptoms in all of medicine. Vestibular migraine shares features with benign paroxysmal positional vertigo (BPPV), Meniere’s disease, vestibular neuritis, anxiety-related dizziness, low blood pressure, inner-ear disorders, and more. Because the symptom itself is so common and so nonspecific, the specific cause is easy to overlook without a careful history.

3. Testing Is Often Normal

Between attacks, and even during many attacks, standard tests — inner-ear testing, hearing tests, MRI scans, blood work — frequently come back normal in vestibular migraine. This is actually consistent with the diagnosis, because VM is a problem of brain processing rather than structural damage. But normal tests can leave patients feeling disbelieved, as though nothing is really wrong. Nothing could be further from the truth.

4. Patients Are Frequently Told It Is “Just Anxiety” or “Just Your Neck”

This is the part I most want to address fairly, because I see it hurt people. When the tests are normal and the headache is absent, patients are often told the problem is psychological, or that it is coming from their neck, and then sent on their way. Anxiety and neck factors are real and can genuinely contribute to how someone feels — but using them as a catch-all explanation, without properly considering vestibular migraine, does patients a disservice.

Two things can be true at once. You can have real neck tension, real anxiety about your unpredictable symptoms, and an underlying vestibular migraine driving the episodes. Anxiety is frequently a consequence of unexplained dizziness, not only a cause of it. Being told “it’s all in your head” when you have a genuine neurological condition is both inaccurate and demoralizing. You deserve a real diagnostic process.

5. The Migraine History Is Buried in the Past

Because many people’s classic migraines occurred decades earlier and then faded, they may not even mention that history when describing current dizziness. They think of it as unrelated ancient history. Yet that past migraine history is often the single most important clue to the current diagnosis.

How Silent Vestibular Migraine Is Diagnosed

Vestibular migraine is a clinical diagnosis. That means it is made primarily from your story and examination, not from a single test that lights up positive. This is why a careful, patient history is so valuable, and why the right clinician matters so much.

The Two Anchors: Migraine History Plus Vestibular Symptoms

Diagnosis rests on connecting two things:

A history of migraine (current or past), and
Recurrent episodes of vestibular symptoms of at least moderate intensity and characteristic duration.

For a diagnosis of vestibular migraine, clinicians generally look for a pattern along these lines:

Repeated episodes of vestibular symptoms (vertigo, unsteadiness, or motion-triggered dizziness) of moderate or severe intensity, each lasting between about five minutes and 72 hours.
A current or past history of migraine (with or without aura), following recognized migraine criteria.
Migraine features accompanying at least half of the vestibular episodes — such as a one-sided, pulsating, or moderate-to-severe headache; sensitivity to light and sound; or visual aura.
Symptoms that are not better explained by another vestibular or neurological disorder.

Notice something important: those migraine features need to accompany only some of the vestibular episodes. Many attacks can be entirely headache-free and the diagnosis still holds. This is precisely how the framework accommodates silent, acephalgic attacks. A single episode with light and sound sensitivity, or a documented history of migraine, can supply the migraine link even when most of your dizzy spells come with no pain at all.

The Value of a Symptom Diary

Because attacks are episodic and testing is often normal, a written record of your episodes is one of the most useful diagnostic tools available. For a few weeks, try noting:

When each episode starts and how long it lasts
What the sensation was (spinning, rocking, swaying, unsteady)
Any triggers you noticed (poor sleep, skipped meals, hormonal cycle, weather changes, red wine, aged cheese, bright or flickering light, stress let-down, visual overload)
Any accompanying features (light or sound sensitivity, nausea, visual changes, head pressure)
Whether a headache occurred, and if so, where and how severe

This kind of record often reveals the migraine pattern that a single office visit cannot, and it helps your clinician immensely.

What the Diagnostic Workup May Include

A thorough evaluation for dizziness typically involves:

A detailed history, including your lifetime migraine history and family history
A neurological examination and bedside balance and eye-movement testing
Hearing and inner-ear (vestibular) testing to look for other causes
In selected cases, imaging such as an MRI to rule out other conditions

Much of this workup is done to exclude other diagnoses. When those come back normal and the history fits, vestibular migraine becomes the leading explanation. The proper professionals to lead this process are typically a neurologist, an otolaryngologist (ear, nose, and throat physician), or a specialist in vestibular disorders, often working alongside a vestibular physical therapist.

Conditions That Can Mimic or Accompany It

Part of a good diagnosis is distinguishing vestibular migraine from its look-alikes:

BPPV (benign paroxysmal positional vertigo): brief spinning triggered by specific head positions, caused by displaced inner-ear crystals. It is often quickly identified and treated with repositioning maneuvers.
Meniere’s disease: vertigo episodes with fluctuating hearing loss, ringing, and ear fullness on one side. VM and Meniere’s can overlap and sometimes coexist.
Vestibular neuritis: a single prolonged episode of severe vertigo, usually after a viral illness, rather than recurrent episodes.
Persistent postural-perceptual dizziness (PPPD): chronic non-spinning dizziness worsened by upright posture and motion, which can develop after, or alongside, vestibular migraine.
Cervicogenic dizziness: unsteadiness related to neck dysfunction and abnormal neck sensory input, discussed in detail below.
Anxiety and panic: which can both mimic and accompany vestibular symptoms.

Because these can coexist, an accurate diagnosis sometimes means identifying more than one contributor at the same time.

What the Research Says

The medical literature has increasingly recognized vestibular migraine over the past few decades, and several landmark papers shaped that understanding.

Early work formally connected migraine and vertigo as related phenomena. A foundational study of the interrelations of migraine, vertigo, and migrainous vertigo, published in Neurology in 2001, examined how often vertigo and migraine occur together and helped establish that the association is far stronger than chance, laying the groundwork for the modern concept of vestibular migraine.

The real-world burden of the condition became clearer with a population study on migrainous vertigo: prevalence and impact on quality of life, published in Neurology in 2006, which documented that migraine-related vertigo is more common than many clinicians assumed and meaningfully reduces quality of life — reinforcing that this is a widespread and disabling problem, not a rare curiosity.

The clinical picture — including how often attacks occur without headache — was detailed in a careful case series on episodic vertigo related to migraine, describing 90 cases and asking whether this represented a distinct entity of vestibular migraine, published in the Journal of Neurology in 1999. This work helped characterize the varied duration and features of attacks and the frequent dissociation between vertigo and head pain.

A comprehensive modern overview appears in Vestibular Migraine I: Mechanisms, Diagnosis, and Clinical Features, published in Seminars in Neurology in 2020, which synthesizes current understanding of the underlying brain mechanisms, the diagnostic approach, and the wide range of ways vestibular migraine can present — including headache-free attacks.

Finally, the formal, internationally recognized diagnostic criteria were established in the consensus document on vestibular migraine diagnostic criteria by Lempert and colleagues, published in the Journal of Vestibular Research in 2012. These criteria give clinicians a shared, structured way to make the diagnosis and specifically account for the fact that many attacks lack head pain, so long as a migraine history and characteristic vestibular symptoms are present.

Taken together, this body of work supports three points that matter for you: vestibular migraine is common, it is often overlooked, and a diagnosis can be made even when headaches are absent from the dizzy episodes, as long as the broader migraine picture is recognized.

How Vestibular Migraine Is Typically Managed

While this article focuses on understanding and diagnosis, it helps to know that management exists and can make a real difference. Because vestibular migraine is a neurological disorder, its care is led by neurology and vestibular specialists, and commonly includes:

Lifestyle and trigger management: consistent sleep, regular meals, hydration, stress regulation, and reducing individual dietary and environmental triggers.
Vestibular rehabilitation therapy: specialized physical therapy that helps the brain adapt and improves balance and motion tolerance.
Medications: both acute options for attacks and, for frequent or disabling episodes, preventive medications drawn from the broader migraine treatment toolkit. These decisions belong with your physician.
Managing coexisting conditions: addressing anxiety, sleep disorders, or other contributors when present.

Many people find meaningful relief through a combination of these approaches, tailored over time. Patience is often required, because finding the right combination can take several adjustments.

Where Upper Cervical Chiropractic Fits — Honestly

I want to be direct with you about our role, because you deserve straight talk rather than marketing.

Vestibular migraine, including its silent form, is a neurological migraine disorder. There is no evidence that upper cervical chiropractic care treats, cures, or prevents vestibular migraine. If any provider tells you that adjusting your neck will make your vestibular migraine go away, that claim is not supported. Your primary path forward for VM runs through neurological and vestibular evaluation and care. I will always encourage you to pursue that.

So why would an upper cervical chiropractor write about this at all, and where could we genuinely help?

The answer lies in a separate, real phenomenon called cervicogenic dizziness. Your neck — especially the upper cervical spine — is densely packed with sensory receptors that feed your brain constant information about head position and movement. Your brain blends that neck input with signals from your inner ears and your eyes to create your sense of balance. When the neck’s sensory input is disturbed, it can contribute to unsteadiness and disorientation. This is a genuine but entirely separate balance factor from migraine.

Here is where fairness matters most. People with dizziness but no headache are frequently told, in a dismissive way, that “it’s just your neck.” That is often used as a way to end the conversation rather than to actually investigate. The truthful, careful position is this: the neck can be one real contributor to how balanced or unbalanced a person feels, but it should not be used as a catch-all explanation that lets a possible vestibular migraine go undiagnosed.

So our role, when it applies, is adjunctive and coordinated, never a substitute for neurological care. If you have a neck-related component alongside your vestibular migraine — or if part of your unsteadiness turns out to be cervicogenic — addressing the neck may support your overall comfort and function while your neurologist or vestibular specialist manages the migraine disorder itself. We aim to work alongside your medical team, not instead of it.

How We Approach the Neck at Our Practice

At Lavender Family Chiropractic, our upper cervical work is built around precision and gentleness. Our care is precise, gentle, and low-force. There is no twisting, cracking, or popping. To guide that care carefully, we use:

3D CBCT imaging (cone-beam computed tomography) to see the detailed anatomy of the upper cervical spine, so that any care is based on your individual structure rather than guesswork.
Paraspinal infrared thermography to assess patterns in the tissues alongside the spine.
The Knee Chest Upper Cervical technique, a low-force method that avoids the forceful, twisting manipulation many people associate with chiropractic.

If you come to us with dizziness, our first commitment is honesty about what we are seeing and whether a neck component is even present. If your story points toward vestibular migraine, we will say so and encourage the appropriate neurological and vestibular evaluation. If we believe a cervical factor is contributing, we will explain how, and we will coordinate rather than compete with your medical care. And if we do not think we can help, we will tell you that too.

Red Flags: When to Seek Prompt Medical Attention

Most dizziness is not dangerous, but certain features can signal something more serious and warrant urgent evaluation. Seek emergency care or contact a physician promptly if dizziness or vertigo occurs with any of the following:

Sudden, severe headache unlike any you have had before (“the worst headache of my life”)
Weakness, numbness, or drooping in the face, arm, or leg, especially on one side
Difficulty speaking, slurred speech, or trouble understanding others
Sudden vision loss, double vision, or trouble seeing
Sudden hearing loss in one or both ears
Trouble walking, severe loss of coordination, or falling
Fainting, chest pain, or an irregular or racing heartbeat
Persistent vomiting that prevents you from staying hydrated
New, constant, or steadily worsening dizziness rather than distinct episodes
Dizziness following a head or neck injury

These symptoms can point to conditions that require immediate treatment, including stroke. When in doubt, err on the side of getting evaluated urgently. Vestibular migraine is a diagnosis made after dangerous causes have been considered and excluded, which is another reason proper medical evaluation matters.

Putting It All Together

If you take one message from this article, let it be this: dizziness and vertigo without a headache do not rule out migraine — they may be migraine, expressed through your balance system instead of through pain. Silent vestibular migraine is common, frequently missed, and eminently recognizable once someone thinks to look for it. The absence of head pain is not a reason to doubt yourself or to accept a vague dismissal.

You deserve a real diagnostic process led by clinicians who understand vestibular disorders. You deserve to have your past migraine history taken seriously as a clue. And you deserve honesty from every provider you see, including chiropractors, about what can and cannot help.

At our practice, that honesty means telling you plainly that vestibular migraine is a neurological condition we do not treat, cure, or prevent, while offering careful, gentle attention to any genuine neck-related balance factor as one piece of a coordinated approach. If your symptoms point toward vestibular migraine, our role is to help you understand that and to encourage the neurological and vestibular evaluation that will serve you best.

Serving Sarasota and the Surrounding Communities

Lavender Family Chiropractic (NeckWise North Sarasota) proudly serves patients throughout Sarasota, Bradenton, Lakewood Ranch, University Park, Palmetto, Ellenton, Osprey, Nokomis, Venice, and the surrounding Gulf Coast communities. Many of the people we meet have spent a long time searching for answers to unexplained dizziness, and we consider it a privilege to help them think clearly about what is happening and where to turn.

If you live with dizziness or vertigo — with or without headaches — and you would like a careful, honest conversation about whether an upper cervical neck factor could be part of your picture, we would be glad to meet you. We will always encourage proper neurological and vestibular diagnosis, and we will tell you truthfully how, or whether, we can help.

We invite you to schedule a complimentary consultation with our doctors to talk it through.

Lavender Family Chiropractic (NeckWise North Sarasota) 5899 Whitfield Avenue, Suite 107 Sarasota, FL 34243 (941) 243-3729

This article is for general educational purposes only and is not medical advice. It does not diagnose or treat any condition and is not a substitute for evaluation by a qualified healthcare professional. Vestibular migraine is a neurological disorder that should be diagnosed and managed by appropriate medical specialists. If you experience any of the red-flag symptoms described above, seek prompt medical attention. Individual results and experiences vary.