Vestibular Migraine (VM) is a neurological disorder affecting the balance systems of the inner ear and brain, which causes episodes of vertigo or dizziness. VM is a subtype of migraine, but a defining headache is often absent. The primary symptom is a false sensation of motion or unsteadiness. The duration of attacks is highly variable because the disorder involves a disruption of central balance circuits.
The Typical Duration of Acute Vestibular Attacks
Acute Vestibular Migraine attacks are defined by specific diagnostic criteria established by the International Headache Society and the Bárány Society. These criteria state that primary vestibular symptoms must last between five minutes and 72 hours. Symptoms may include spontaneous vertigo, which is the sensation that the room is spinning, or dizziness induced by head motion. The variability within this 5-minute to 72-hour window is significant, and attacks often fall into distinct patterns. Approximately 30% of people experience brief attacks lasting only minutes, while another 30% have episodes lasting several hours, commonly between four and 24 hours. This duration refers only to the intense, acute period of vertigo.
Understanding Residual Symptoms and Chronic Patterns
The timeline of an acute attack does not account for the lingering effects that can persist long after the spinning sensation subsides. Once the severe vertigo ends, many people enter a phase known as postdrome, where less intense symptoms remain for days or even weeks. These residual symptoms often include motion sensitivity, slight unsteadiness, or a general feeling of “brain fog” that makes concentration difficult. For some individuals, the condition can evolve into a chronic pattern, which is defined by the frequency of episodes over time. A chronic variant of VM is having vestibular symptoms on at least 15 days per month for more than three months. Episodes of acute vertigo are often superimposed on this persistent background dizziness, which is common among VM patients.
Key Factors Influencing Attack Length
Several personal and environmental factors influence whether an acute VM episode stays brief or stretches toward the 72-hour maximum. Early intervention is a major factor that can significantly shorten an attack’s duration. This often involves using acute-treatment medications like triptans or antiemetics at the first sign of symptoms. Immediate rest and withdrawing from stimulating environments, such as those with bright lights or loud noises, can also prevent the attack from escalating. Conversely, delaying treatment or ignoring early warning signs contributes to a longer, more severe episode. Common migraine triggers like stress, hormonal fluctuations, and poor sleep hygiene are known to lengthen and intensify VM attacks. Dietary triggers, such as irregular meal times, dehydration, or consuming alcohol or excess caffeine, can also prolong the neurological cascade. Managing these modifiable factors is a practical strategy to reduce both the frequency and the length of vestibular episodes.