Vestibular migraine triggers: managing time in the city

Vestibular migraine triggers are really diverse, and can of course be within the home and when outside. Simply walking down the street can be tough with this condition, and it can feel as though so many things will trigger or increase dizziness and other symptoms.

I still remember when walking to the pharmacy at the end of my street was something I would put off for days until I had no choice. Thankfully, a range of treatments has meant my symptoms are now far better, but flare-ups still happen. I was reminded of this on a recent trip to central London for a medical appointment. After a year of being home, suddenly there were triggers everywhere!

Triggers for a vestibular migraine attack, or an increase in symptoms, are often individual. These are some of my triggers, but there are many others too.

The aspects of healthcare that have helped me are for informational purposes and do not constitute medical advice. Seeing a specialist doctor is the best way forward for your healthcare.

Jump to:

• 1. Being on public transport
• 2. Crowds
• 3. Open spaces
• 4. Heights
• 5. Uneven ground
• How I cope with vestibular migraine triggers in the city
• 1. Plan your travel ahead of time
• 2. Reduce other triggers before your trip
• 3. Nausea relief bands
• 4. Migraine glasses
• 5. Eat and drink in a consistent way
• Related posts
• 💬 Comments

1. Being on public transport

I hadn't been on a train for over a year, and was very nervous about it for my trip to central London. It took about two years of awful vertigo attacks and severe dizziness until my head just seemed to get used to trains (it still doesn't like buses). So I was very worried that after so long the movement would trigger an attack.

Movement in various forms is an issue for many with vestibular migraine. Others that spring to mind are being in a car, going down a slide with my niece (what was I thinking?!), being on a boat and simply turning my head too fast.

2. Crowds

While London is quieter at the moment, it can be busy in certain areas and that busy movement can feel very overwhelming. All the movement, along with the noise that often goes with it, is a trigger for an increase in vestibular migraine symptoms for me. My head feels as though it cannot cope with all the movement. I want to close my eyes and make it all stop.

Stress is also a trigger for migraine (VeDA). Being somewhere that is going to involve triggers can itself cause anxiety, either before or during the outing. Personally I avoided being 'out' for quite some time, which in the longer-term wasn't helpful.

3. Open spaces

Opposite to crowds is open spaces, where there aren't too many 'anchors' as my vestibular rehabilitation therapist calls them. There aren't too many fixed objects to focus on, and so my vestibular migraine brain gets upset (again!).

On a sunny day in an open space there is also bright light to contend with, another recognised trigger of an attack (American Migraine Foundation). Going for a walk in the countryside can be lovely, but it is definitely a time when I have my sunglasses or migraine glasses on!

4. Heights

One of my symptoms during an attack is a sense of falling, and this is a recognised symptom of the condition (American Migraine Foundation). It can be a sudden, violent almost, feeling and is quite scary. So being up high feels even more scary as there is an element of fear that I am going to fall - from a height. Perhaps that sounds silly, but those with vestibular migraine may know what I mean.

Heights then, bother me in two ways. The most obvious being up high - it took a long time for me to pluck up the courage to go up a tall building as my head would spin and I would grip the floor with my toes until they hurt. I still don't like heights, and definitely don't do it for 'fun' very often.

The other way is simply looking up at a tall building. It also makes my head spin. I can't quite figure out why, but it's another thing that I try and avoid. A bit tricky in certain areas of London where tall buildings are everywhere!

5. Uneven ground

With balance being affected for those with vestibular migraine, walking on uneven ground can be a really challenging experience.

Many of us get a 'feel like you are walking on a bouncy house' sensation with vestibular migraine. My neuro-otologist also describes it as feeling as though you are walking on cotton wool, or on clouds. It's a strange experience of streets that feel as though they are moving up and down, left to right. So, of course, combine this feeling with uneven, loose ground or cobblestones and it can be a recipe for increased symptoms for many of us.

How I cope with vestibular migraine triggers in the city

Eliminating triggers in a big city is pretty much impossible, but if travel is necessary (which it often is in daily life, despite vestibular migraine) then I do a few things to try and help lower my susceptibility to a big attack:

1. Plan your travel ahead of time

Planning my journey is the most important aspect of coping with vestibular migraine triggers for me. As my head does not like buses, I stick to trains or walking. The latter two can still be a trigger but are less so than a bus. This is likely personal, and one Instagram friend said to me the exact opposite - she is good with buses, but not with trains.

Some other suggestions:

• travel off-peak if possible when it is less busy and there are more likely to be seats on transport.
• 'please offer me a seat' badges are available in London, and can be very helpful on transport.
• if you are walking between appointments or to the shops etc. then plan a route that is less crowded.
• some areas of London are full of cobbled streets. If I am symptomatic I will avoid these areas if possible.
• avoid tall buildings if you can. Meeting a friend for a coffee? Suggest a ground-level coffee shop, not one on the 20th floor!

2. Reduce other triggers before your trip

One of my doctors explained to me that migraine can work on the bucket theory - you can tolerate a certain amount of triggers going into your bucket, but one too many and then the bucket overfills and you can get an attack.

So for me I try and reduce triggers a day or two before my trip. This means that I wouldn't do certain forms of exercise, go to a busy supermarket or watch flashing lights on TV. And of course, I would try to sleep well and have a more relaxed day beforehand. Stress is definitely a recognised migraine trigger (NHS).

Working on pacing can also be very helpful in managing energy levels and symptoms.

3. Nausea relief bands

With dizziness comes nausea for many of us. Travelling on trains or buses can increase that nausea, and make us feel rotten.

Nausea relief bands are a really helpful drug-free way to help manage nausea and are always on my wrists when I have this symptom. My favourite are the Blisslets nausea relief bands as they don't look 'medical' and just look like cute jewellery instead.

Blisslets has kindly given my readers a discount on their bands - use the code fibrofog for 15% off!

4. Migraine glasses

I use migraine glasses in two ways as a way to manage triggers. For me, bright lights and strong sun can be a trigger, as can watching TV or using a computer in the evening when it is dark.

Migraine glasses are therefore really useful in both scenarios. Wearing them the night before while watching my favourite show helps 'calm' my brain down, and wearing them in strong sun while out and about does the same.

Personally I like two brands. The first is Avulux migraine glasses which block harmful light spectrums, such as blue and amber light, while allowing soothing green light in. Avulux has kindly offered my readers $25 USD off with the code Throughthefibrofog

The second is Migraine Shields glasses, and they have kindly offered my readers 20% off with the code throughthefibro

5. Eat and drink in a consistent way

The migraine brain likes consistency, which means regular meal times are essential (The Migraine Trust). If you are out and about, then sticking to set mealtimes can be tricky, especially if you are at appointments that overrun or out with friends. So there is always a snack in my bag!

Dehydration is another potential trigger, and the American Migraine Foundation describes that ⅓ of people report this as a trigger. So along with my snack, there is always, always, always a bottle of water in my bag (can you tell I am very resolute about this one!). Without water I am going to have an attack within an hour or so.

Let me know in the comments if there are any other ways you manage vestibular migraine triggers so we can help each other! For helpful information on managing vestibular disorders, the VeDA website is definitely a go-to for me.

I'm active on Instagram and Twitter if you would like to follow along for more posts like this!

Related posts

Avulux migraine glasses review

Living with vestibular migraine

10 travel tips for vestibular disorders and migraine

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Please follow the advice of your doctor as to all medical treatments, supplements and dietary choices, as set out in my disclaimer. I am not a medical professional, and this post, as well as all other posts on this blog, are for informational purposes only.