Some patients with Lyme disease develop vestibular migraine—also referred to as vestibular syndrome—during the course of their illness. In others, vestibular migraine may be an early neurologic manifestation or even a presenting complaint before Lyme disease is recognized. Symptoms may include vertigo, imbalance, sensitivity to light or smells, motion intolerance, and worsening with stress or certain foods. In many cases, patients undergo extensive ear evaluations and even procedures, yet symptoms persist until a clinician familiar with vestibular disorders recognizes the underlying neurologic pattern.
This presentation reflects a clinically recognized overlap between Lyme disease and vestibular migraine, particularly when neurologic involvement is subtle or missed early.
This association does not imply that Lyme disease causes vestibular migraine in all cases, but rather that it may contribute to neurologic vulnerability in some patients.
When Lyme Disease Affects Balance
Lyme disease can involve both the central and peripheral nervous system, including pathways responsible for balance, spatial orientation, and sensory integration. When these systems become inflamed or dysregulated, patients may develop symptoms that closely resemble vestibular migraine.
Common features include vertigo, rocking sensations, motion sensitivity, nausea, imbalance, and heightened sensitivity to light, sound, or smells. Symptoms often worsen with stress, poor sleep, visual stimulation, or dietary triggers. Routine testing is often unrevealing, which can complicate early recognition.
Vestibular Migraine and Lyme Disease: Understanding the Clinical Overlap
Vestibular migraine is a neurologic condition characterized by dizziness or vertigo associated with migraine physiology, even in the absence of classic migraine headache. In the context of Lyme disease, vestibular migraine may be triggered or unmasked by neurologic and autonomic disruption.
Several mechanisms may be involved simultaneously. Neuroinflammation can affect the brainstem, cerebellum, and vestibular nuclei, which are central to balance and motion processing. Autonomic nervous system disruption can amplify sensory input, making the brain hypersensitive to light, sound, motion, and smells. Central sensitization may develop, leaving the nervous system in a prolonged state of heightened reactivity. Immune activation may also play a role, as migraine itself is considered an inflammatory neurovascular condition.
In susceptible individuals, Lyme disease may act as a precipitating or amplifying factor rather than a sole cause.
Why Vestibular Symptoms May Appear Early in Lyme Disease
In some patients, vestibular symptoms appear early in the course of Lyme disease, sometimes before a formal diagnosis is made. This timing is clinically meaningful. It suggests that vestibular migraine may serve as a neurologic clue rather than a late complication.
When evaluation focuses narrowly on the inner ear, the broader neurologic context may be overlooked. Patients are often told their ears appear normal or that imaging is reassuring, yet symptoms persist. While these findings may be accurate, they do not explain the ongoing dysfunction.
Recognizing this pattern requires neurologic pattern recognition rather than reliance on a single test.
Why Ear-Based Interventions Often Fail
When dizziness is driven by central or neuroinflammatory processes, ear-based procedures are unlikely to resolve symptoms because the underlying problem is neurologic rather than mechanical. The inner ear may appear normal because it is not the primary source of dysfunction.
As a result, some patients undergo repeated evaluations and interventions before the neurologic pattern is recognized. Identification of vestibular migraine in the setting of Lyme disease often requires clinicians familiar with both vestibular disorders and systemic or infectious illness.
Diagnosis Requires Pattern Recognition
Vestibular migraine is diagnosed clinically. There is no single confirmatory test. Similarly, neurologic manifestations of Lyme disease often require pattern recognition rather than reliance on one diagnostic study.
The presence of vertigo, sensory hypersensitivity, motion intolerance, and migraine-like features in patients with suspected or confirmed Lyme disease should prompt a broader neurologic evaluation rather than premature diagnostic closure.
Symptoms often cross traditional specialty boundaries, which can delay recognition when evaluation remains siloed.
Vestibular migraine does not exclude Lyme disease; in some cases, Lyme is a contributing driver.
Treatment Is Multidimensional
Management typically requires addressing multiple factors. This may include evaluating active infection or post-infectious inflammation, reducing neuroinflammation, stabilizing autonomic function, and implementing migraine-specific strategies such as dietary modification, sleep regulation, and sensory pacing. During symptom flares, minimizing overstimulation is often essential.
Equally important is appropriate reassurance. These symptoms are not imagined and should not be attributed solely to anxiety in the absence of careful neurologic assessment.
Clinical Takeaway
Vestibular migraine can occur in Lyme disease as an early manifestation, a presenting neurologic feature, or part of a broader pattern of neurologic involvement—even when ear exams and imaging are normal. This presentation is clinically plausible and increasingly recognized.
When patients with Lyme disease present with vertigo, sensory sensitivity, light intolerance, and motion sensitivity, vestibular migraine should prompt deeper neurologic evaluation—not diagnostic dismissal. Recognition allows for more appropriate management and improved patient outcomes.
References
- Lempert T, et al.
Vestibular migraine: diagnostic criteria.
Neurology. 2012.
https://pubmed.ncbi.nlm.nih.gov/23142830/ - Villar-Martinez MD, Goadsby PJ.
Vestibular migraine: an update.
Current Opinion in Neurology. 2024.
https://pubmed.ncbi.nlm.nih.gov/38619053/ - Smyth D, et al.
Vestibular migraine treatment: a comprehensive practical review.
Brain. 2022.
https://pubmed.ncbi.nlm.nih.gov/35859353/ - Huang TC, et al.
Vestibular migraine: an update on current understanding.
Journal of Neurology. 2020.
https://pubmed.ncbi.nlm.nih.gov/31394919/ - Johns Hopkins Medicine.
Vestibular Migraine.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/vestibular-migraine - Dr. Daniel Cameron: Lyme Science Blog. Lyme disease triggers vertigo and hearing loss
- Dr. Daniel Cameron: Lyme Science Blog. Lyme disease patient with permanent tinnitus and hearing loss
- Dr. Daniel Cameron: Lyme Science Blog. Central sensitization syndrome worsens Lyme disease symptoms?
