Vestibular migraine postdrome: the floor keeps moving after the attack ends.

The attack ended yesterday. The grocery aisle didn't get the memo.

The spinning stopped sometime last night. There's no headache this morning, and maybe there never was much of one, since plenty of vestibular migraine attacks run with little or no head pain. You shower. You get dressed. You feel mostly like yourself.

Then you walk into a supermarket.

The shelves slide at the edge of your vision. The floor tilts a fraction when you turn to grab the milk, and you notice your hand has settled on the cart for balance. By the checkout, reading a price tag feels like wading through something thick.

Is this the attack still going? A new one starting? Or something that doesn't have a name in your app? Most migraine logs offer two options, attack or no attack. So this morning gets recorded as a good day, or it doesn't get recorded at all.

Residual disequilibrium: the vestibular after-phase

We call it residual disequilibrium, and it's worth naming precisely, because 'still a bit dizzy' flattens three distinct things into one shrug.

First, postural unsteadiness. A rocking or off-balance sense when standing or walking, often worse with quick head turns or bending down. It usually feels different from the rotational vertigo of the attack itself: less violent, more like the ground can't be fully trusted.

Second, visual motion sensitivity. Busy visual environments, scrolling screens, patterned floors, riding as a passenger. These provoke or amplify the unsteadiness, sometimes when sitting perfectly still.

Third, cognitive fog. Slowed processing, lost words, trouble holding a thread of thought.

Fatigue can be in the mix too. But in how people with vestibular migraine describe their recovery, in forums like r/VestibularMigraines and in clinic, the balance and visual symptoms are what they lead with. The after-phase is vestibular first.

Why 'postdrome means tired' misses vestibular patients

The postdrome most people know was mapped in headache-dominant migraine. In one of the best-known studies, an electronic diary study by Giffin and colleagues in Neurology (2016), the large majority of patients reported non-headache symptoms after the pain resolved, and tiredness led the list.

That's a real and useful finding. It also became the template. Symptom trackers built on it offer fatigue, brain fog, neck stiffness and mood as the after-phase menu.

So a vestibular patient opens the app the day after an attack and hits a wall. No pain, not especially exhausted, but can't walk down an aisle without steadying. They either log nothing, or they tick 'fatigue' because it's the closest box.

And the neurologist reading that log learns one thing: this person was tired. Nothing says the vestibular system took two more days to settle.

How long does vestibular migraine last after the attack ends?

Honest answer: the vestibular after-phase is thinly studied, so be skeptical of any single number you find online.

What's firmly defined are the edges. Under ICHD-3 and the Bárány Society criteria, a vestibular migraine episode runs from 5 minutes to 72 hours. For migraine postdrome in general, published diary data puts duration at a few hours up to 72 hours, with published research reporting an average duration around 25 hours for those who experience it. For vestibular patients specifically, the research doesn't converge on a clean number. Residual dizziness after an attack is reported, but not with the kind of consistent duration data that would let anyone quote a range with confidence.

The other edge matters more for diagnosis. Persistent postural-perceptual dizziness (PPPD) requires unsteadiness or non-spinning dizziness on most days for 3 months or more, typically worse upright, with motion, and with complex visual scenes. Vestibular migraine is one of the recognized triggers for it.

So there's a gradient. The attack. An after-phase that tapers. And a state that stops tapering. The symptoms can look alike on any single day. The trajectory is what separates them.

The same month, logged two ways

Picture a hypothetical patient with three vestibular attacks in a month.

Log A records the attacks: start time, end time, severity. Between them, blank days. At the appointment, the neurologist sees three episodes and a month that otherwise looks fine.

Log B records the same attacks, then rates unsteadiness, visual motion sensitivity and fog each morning and evening afterward, until two days in a row sit at the patient's normal. After the first attack, the ratings clear by day two. After the second, day three. After the third, they don't fully clear before the next attack arrives.

That third stretch is the whole story. It could be a slow recovery. It could be the early shape of a baseline that's stopped resetting. Either way, Log A can't show it, because Log A never asked.

What changes when the after-phase gets its own line

If residual disequilibrium is logged as its own phase, three conversations get better.

The diagnostic one. A resolving after-phase and a non-resolving one lead to different workups, and PPPD can coexist with vestibular migraine. A clinician can only weigh that if the log shows whether you returned to baseline between attacks.

The treatment one. Attack frequency is what preventives are usually judged on. But a preventive that shortens your recovery from three days to one is doing something real, and you'd never see it in an attack count. Whether vestibular rehabilitation belongs in the plan is also easier to discuss with a recovery curve on the table.

The practical one. Knowing your after-phase typically runs a set length lets you plan around it, like not booking the highway drive or the open-plan office day that follows an attack.

We think this is the single most useful change a vestibular patient can make to how they track.

A tracking method that fits a foggy, unsteady brain

Postdrome was built on the idea that the after-phase is its own phase, with its own place on a continuous symptom timeline rather than a blank gap between attacks. For vestibular migraine, that's the difference between a pain-free, unsteady Tuesday existing in your record or vanishing from it.

The method we'd suggest, in any tool: rate unsteadiness, visual motion sensitivity and fog on a simple 0 to 3 scale, morning and evening, starting when the attack ends. Note what provoked each one: head turns, screens, a car ride, a busy store. Stop when you've had two consecutive days at your own normal, and write down what your normal actually is.

Aura Mode keeps logging low-stimulation for the moments when a bright, busy screen is part of the problem. Your data stays on your device, it exports cleanly for your appointment, and the app is a single lifetime purchase, no subscription.

When unsteadiness isn't the after-phase

Residual disequilibrium should trend one direction: back toward your baseline. If it isn't, or if something feels unlike your usual attacks, that's a conversation for your clinician, not your log.

If post-attack unsteadiness is lasting longer each time, or you haven't felt steady between attacks for weeks, bring the ratings to your neurologist and ask directly about persistent vestibular dysfunction.