Occipital Headaches More Frequent Among Those With Vestibular Migraine

internal ear
Patients with vestibular migraine are more likely to have occipital headaches than those without vestibular symptoms.

Headaches in the occipital region were more common among individuals with vestibular migraines. These findings, from a retrospective cross-sectional study, were published in Headache.

Patient charts were analyzed for all individuals (N=169) who received care at the University of Iowa Hospitals and Clinics for headaches or vertigo between 2008 and 2014. Participants were assessed by questionnaire for balance, vertigo, dizziness, presence of headache, headache location, and headache characteristics.

The majority of participants reported having vestibular migraines (VM; n=103) compared with those experiencing migraines without vestibular symptoms (M; n=66). Individuals in the 2 migraine groups differed significantly for age of headache onset (28±12 years vs 17±9 years; P <.001), headache location (P =.032), and motion sickness since childhood (42% vs 2%; P =.001) for VM and M cohorts, respectively.

Among the VM group, 44% reported their headache location as occipital compared with 18% in the M group (P <.001). The odd’s ratio (OR) for experiencing an occipital headache among the VM group was 3.5 times higher compared with non-vestibular migraines (95% CI, 1.7-7.2).

Among patients reporting their headache as located in the occipital region, 53% of the VM group had exclusively occipital headaches compared with 25% in the M group (P =.081).

Patients in the VM group were more likely to develop their symptoms after 20 years of age (57% vs 19%; OR, 5.77; 95% CI, 2.62-12.10; P <.001) and vestibular symptoms manifested much later than their headache onset (3 years; P =.005). The age of headache onset and vestibular symptoms were significantly associated (R2, 0.763; P <.001).

Patients with VM headaches were more likely to have a family history of motion sickness (OR, 13.48; 95% CI, 3.47-58.61; P <.001) and less likely to experience aura (OR, 0.07; 95% CI, 0.01-0.27; P <.001) or vomiting (OR, 0.46; 95% CI, 0.24-0.92; P <.001).

The conclusions drawn from these observations were that vestibular migraines were more likely to manifest as occipital headaches compared against patients with non-vestibular migraines.

Patients at high risk for developing vestibular headaches may present with a history of motion sickness, late onset of headache symptoms, and with headaches located in their occipital region.


Wattiez A S, O’Shea S A, Eyck P T, et al. Patients with vestibular migraine are more likely to have occipital headaches than those with migraine without vestibular symptoms. Published online July 25, 2020. Headache. doi:10.1111/head.13898