Vestibular migraine without headache: what to log, what to say, what to bring.

Your tracker wants a pain score. You had zero.

The New York Times recently ran a piece on vestibular migraine without headache. For a lot of readers it was the first time a mainstream outlet had called their dizzy spells migraine, and threads on r/migraine picked it up.

Then the next attack comes. The kitchen floor won't stay level, your ears feel full, and you end up sitting on the tiles until it passes. Later you open a migraine app to log it, and the first question is how bad the pain was, on a scale of 0 to 10.

It didn't hurt. So the entry feels wrong, and you close the app.

That closed app is the gap the coverage left. The article gave you the right word but stopped before the record that gets that word onto a chart.

No pain anchor, no record

Call it the pain-anchor problem. Most migraine logging, paper diaries included, starts with the headache: when it started, where it hurt, how bad, what you took. Every other symptom hangs off that first field.

A vestibular attack without headache has nothing to hang from. So it doesn't get logged at all, or it goes in as a 1 out of 10, which reads like a mild day.

And that's how the record ends up working against you. A clinician flipping through months of entries sees occasional light headaches. The afternoons you spent holding onto the counter aren't there, because the form had no place for them. The pattern that would point toward vestibular migraine is the one pattern that kind of log can't hold.

The fix is unglamorous. Log the episode, and treat headache as one field among several.

What the diagnostic criteria actually count

'Keep a headache diary' is standard advice, and for most migraine it's fine. For vestibular presentations it points you at the wrong event.

Clinicians diagnose vestibular migraine using criteria published jointly by the Bárány Society and the International Headache Society in 2012 and updated in 2022. Those criteria count vestibular episodes, how long they last, and which migraine features come with them. Headache is one qualifying feature. Light and sound sensitivity together is another. Visual aura is a third. If at least half your episodes have any one of them, that part of the definition is met. So an attack with zero pain can still count as a migraine attack.

There's a history requirement too: current or past migraine. Headaches from your twenties count, so write them down even if they stopped years ago.

Why the wait for a diagnosis runs so long

The diagnostic delay is the number the coverage should have led with. People with vestibular migraine commonly wait years for a name, and for many of them the dizziness is real and disruptive long before anyone says the word migraine.

Part of that is structural. Dizziness often gets routed through the ER, ENT, cardiology and physical therapy before anyone considers migraine, and the condition didn't have shared diagnostic criteria until 2012. Part of it is the record problem above. A patient who arrives with no episode count, no durations and no list of accompanying symptoms leaves a clinician very little to check against those criteria.

Referral pathways are out of your hands. You can control the evidence you bring with you.

How to log a vestibular migraine attack with no pain

Say an episode starts mid-afternoon at your desk. You won't have the focus for a long form, so capture a few things while it's happening and the rest afterward.

During: the start time, what it feels like (spinning, rocking, swaying, unsteady on your feet, sick from head movement or from moving visuals), whether light or sound is bothering you, and any visual aura.

After: when it ended, how disabling it was (could you stand, walk, read a screen), what you took and whether it helped, and anything that lingered afterward, like fatigue or fog.

And write 'headache: none.' Explicitly. A recorded zero tells a clinician the episode happened without pain, which is the exact detail that separates your pattern from an ordinary headache diary.

A recorded zero is data. A skipped entry is just a gap.

What to say to a GP who hasn't heard of vestibular migraine

Use the term, and give them something to check it against. A short version:

'I'm having recurring episodes of vertigo and imbalance, usually without headache. I've had migraine before. I think this could be vestibular migraine, which has published criteria from the Bárány Society and the International Headache Society. Here's my log of the last few episodes. Can you refer me to a neurologist, a headache specialist, or a neuro-otologist?'

Expect questions about other causes. BPPV and Ménière's disease are common ones a clinician will want to rule out, and some will order hearing or balance testing first. That's reasonable. What you're asking for is that migraine stays on the list while they look.

The one-page note for your first neurology appointment

First neurology appointments are short, and they set the direction for everything after. One page, in this order, makes sure the important parts get read. Bring the raw log as backup, but hand over the page first.

Where Postdrome fits

We built Postdrome because the apps we tried stopped at the headache, and a lot of migraine happens outside it. The log is a symptom timeline, so an entry can start from dizziness, light sensitivity or fog instead of a pain score Not quite as written. Every entry carries a 0 to 10 'Intensity' reading, where 0 means feeling normal. Intensity is not framed as pain, and a user can log symptom chips (nausea, brain fog, fatigue, light and sound sensitivity, aura) with no pain description. The vestibular side has separate Dizziness and Vertigo options, but the app has no imbalance or motion-sensitivity option. A safe version of the sentence: 'Entries are logged on a 0 to 10 intensity scale rather than a pain score, with symptom chips that include dizziness and vertigo.'. Aura Mode is built for logging when you can't see straight. Your entries stay on your phone, and you can export them when it's time to write the one-page note. Pricing is lifetime, stated up front.

Diagnosis is your neurologist's job. Postdrome's job is to make sure the attacks that didn't hurt are still on record when someone finally asks.

When dizziness can't wait for an appointment

Vestibular migraine is diagnosed after other causes have been considered, and some causes of sudden dizziness are emergencies. A first-ever bout of severe vertigo deserves a medical assessment even when nothing else seems wrong.