Why do I feel dizzy when my MRI is normal? is it BPPV or vestibular migraine? This is one of the most common questions I hear in my vertigo clinic.
In this blog I will try to explain in simple words so you can clearly understand the difference between vestibular migraine and BPPV.
Vestibular migraine is a brain-based condition, that can cause dizziness with or without headache, can last from minutes to hours.
BPPV, on the other hand, comes from the inner ear that causes brief, intense spinning when you change head positions.
Learn in depth about Vestibular Migraine
Learn in detail about BPPV symptoms and treatment here.
Learn about symptoms, causes & treatment of Vertigo.
Vestibular Migraine (VM) and Benign Paroxysmal Positional Vertigo (BPPV) are two of the most common causes of dizziness. They differ in symptoms, duration, triggers and treatment.
If someone is being treated for BPPV and has undergone the Epley’s maneuver several times without any relief, it may not be BPPV at all. Vestibular migraine can sometimes mimic positional vertigo.
Vestibular migraine is a neurological condition, where dizziness or vertigo is the main symptom. It may happen with or without head pain.
In this condition the brain’s balance system becomes overly sensitive, triggering dizziness episodes (dizzy spells) or vertigo , lasts longer. It can be triggered by stress, hormonal changes, lack of sleep etc.
Benign Paroxysmal Positional Vertigo (BPPV) is a mechanical issue in the inner ear.
Tiny calcium carbonate crystals (otoconia) move into the wrong part of the balance system (the semicircular balance canals), causing brief, intense episodes of spinning vertigo when you change head positions.
BPPV is brief episode of intense positional vertigo, while vestibular migraine episodes lasts longer with other migraine symptoms.
Vestibular Migraine and BPPV have different underlying causes, one starts in the brain’s migraine pathways, the other in the inner ear’s balance organs.
Risk factors:
BPPV is more common in older adults, while vestibular migraine often affects younger women. Stress, poor sleep and hormonal shifts can trigger both.
Here’s a quick comparison-Vestibular Migraine vs BPPV:
Feature | Vestibular Migraine | BPPV |
Cause | Brain sensitivity (migraine pathways) | Inner ear crystal (otoconia) movement |
Duration of dizziness | Minutes to hours | Seconds |
Trigger | Stress, hormones, food, lights, smells, travel | Head movements, change in position |
Associated symptoms | Headache, sensitivity to light/sound, nausea, imbalance | Spinning only, no migraine symptoms |
Nystagmus | Not consistent, may not match a specific semicircular canal | Matches a specific semicircular canal (typical positional nystagmus) |
Treatment | Lifestyle changes, vestibular rehab, migraine medications | Epley or other canalith repositioning maneuvers |
Response to Epley | No effect | Good (immediate improvement) |
Recurrence | Can be episodic or chronic | Common but easy to treat |
Age Group | Any age, often < 50 years | More common after 40 |
In short- BPPV is short-lasting spinning vertigo triggered by head movements, while vestibular migraine is longer-lasting dizziness with migraine symptoms.
Diagnosis usually starts with a detailed patient history and clinical examination.
ENT specialists may perform positional tests like Dix-Hallpike or Roll tests to confirm BPPV; vestibular migraine is diagnosed clinically, based on migraine-related triggers, symptoms and history.
If a patient with vertigo or dizziness visits my vertigo clinic, this is how I diagnose whether it is BPPV or Vestibular migraine.
BPPV can be diagnosed or ruled out within minutes. Vestibular migraine needs a deeper symptoms tracing.
This process helps us to make a clear BPPV or vestibular migraine diagnosis so patients can start the right treatment.
Understanding the difference between VM and BPPV is the first step to getting the right treatment. BPPV treatment involves repositioning maneuvers like Epley, while vestibular migraine management focuses on trigger avoidance, lifestyle changes, and migraine medications.
Learn more about BPPV treatment in detail, here.
Discover vestibular migraine triggers and relief options here.
BPPV often resolves quickly with treatment but can recur; vestibular migraine needs long-term management and life style modifications.
Yes, it is possible to experience both BPPV and vestibular migraine together, a condition where dizziness may persist or recur despite standard BPPV treatment by repositioning maneuver.
Treatment of migraine is crucial for long-term relief and successful treatment of dizziness in such cases.
BPPV and vestibular migraine can overlap and a careful evaluation by an ENT or a vestibular specialist is essential.
Even after Epley maneuvers for BPPV, some patients experience recurrent dizziness, which could be due to coexisting vestibular migraine. Studies suggest that Migraine treatment including lifestyle modification, migraine prophylaxis medications, or trigger control can significantly reduce dizziness episodes .
These steps can help patients dealing with coexisting BPPV and vestibular migraine.
You should visit an ENT specialist as when you experience dizziness or vertigo. People usually visit when-
With a structured step wise assessment, we can differentiate between BPPV and vestibular migraine. ENT consultation ensures accurate diagnosis and a treatment for both BPPV and vestibular migraine.
Dr. Archana Jhawar is a vertigo specialist at Neoalta Clinic, Vashi, Navi Mumbai with 25 years of experience in diagnosing and treating BPPV, vestibular migraine and complex dizziness disorders.
Patients from Vashi, Sanpada, Nerul, Kharghar, Belapur, Koparkhairane Ghansoli and Panvel visit for complete vestibular evaluation including VNG testing and BPPV repositioning maneuver. Call 9322229159.
Yes. Stress is a well-known trigger for vestibular migraine. While stress does not directly cause BPPV, it can worsen dizziness symptoms and delay recovery.
Managing stress through sleep, hydration and lifestyle changes benefits both conditions.
BPPV causes brief spinning lasting seconds, triggered by head movements like turning in bed or bending down.
Vestibular migraine causes longer episodes lasting minutes to hours, often with light or sound sensitivity.
Understanding the difference between vestibular migraine and BPPV is important and it can save months of misdiagnosis.
Yes. Both can occur together. f dizziness persists despite successful Epley maneuver, an underlying vestibular migraine may be contributing.
A detailed vestibular assessment helps identify and treat both conditions.
No. MRI is usually normal in both BPPV and vestibular migraine. Diagnosis is clinical based on symptom history, positional tests and vestibular assessment. VNG testing may be recommended when the diagnosis is unclear.
BPPV is treated with crystal repositioning maneuvers like the Epley, Semont, or Lampert-Barbeque maneuver while vestibular migraine treatment is usually trigger- control, lifestyle modification, and migraine-medication.
The treatments are completely different, which is why accurate diagnosis matters.
Dr. Archana Jhawar ENT specialist and Certified Vestibular Specialist offers vestibular assessment & treatment at Neoalta Clinic, Sector 17 Vashi.
She performs Dix-Hallpike, Roll test, VNG testing and BPPV repositioning maneuvers. Patients from Vashi, Nerul, Kharghar, Belapur, Koparkhairane and Panvel consult her for BPPV and vestibular migraine diagnosis. Call 9322229159.
Hi, I’m Dr. Archana Jhawar, an ENT specialist with over 24 years of experience. I specialize in tinnitus treatment, vertigo , ear care, and ear surgeries, practicing at Neoalta Clinic, Vashi, and Kokilaben Dhirubhai Ambani Hospital in Navi Mumbai. I’ve trained in vertigo management and Rational Emotive Behavior Therapy (REBT), combining science with compassion to offer holistic, evidence-based care. I’m passionate about writing, poetry, music, yoga, and photography.
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