The first time TV journalist Deborah Roberts experienced vertigo was in the late 1980s. She was on assignment with a photographer in Orlando, FL. “We were in a car speeding along, working on some story, when out of the blue I started getting these auras—almost black tunnel vision,” recalls Roberts, who at the time was bureau chief and weekend co-anchor for WFTV, ABC-TV's Orlando affiliate. “I began to feel nauseated and dizzy and was consumed by a major headache. I remember putting the seat back and thinking, ‘What is this? I've never experienced anything like this before.’”

She can't remember exactly what happened with the assignment, but over the next day or so the episode subsided. In the years after that first attack, Roberts would occasionally experience the same symptoms again—some combination of dizziness, nausea, aura (sensory disturbance like flashes of light, blind spots, tingling, or tunnel vision), disorientation, and headache—but she was determined not to let it get in her way.

“Most people know I'm pretty hard-charging and aggressive when it comes to work and getting out there, overcoming, doing whatever I need to do,” says Roberts, 63, who moved to ABC News in 1995 and is now co-anchor of the show 20/20. “I've had times when I've been in the wings, ready to step out on air, and I've had to gather myself and will myself to get through the vertigo. I've had to sit down and do in-depth interviews when I'm experiencing it or even do some type of walking shot with the interview subject when I'm feeling unsteady.”

The worst episode occurred in 2010, when Roberts went on vacation in the Bahamas with her husband, Today weather forecaster Al Roker, and their two children. “I had just been in Colorado on assignment, at high altitude, and I remember that feeling coming over me—the nausea, the queasiness, a sense of uneasiness and dizziness,” she says. “Like if you've been swimming all day and diving really deep in the pool, and at the end of the day your head feels waterlogged. I remember thinking I needed to drink a lot of water.”

Roberts flew directly from Colorado to the Bahamas and felt fine for most of the family holiday. But on the last day, she woke up and could not get out of bed. “The room was spinning. I was so nauseated, if I even sat up and tried to go to the bathroom, it felt like I would pass out. Everything was swirling, and I just wanted to close my eyes,” she says. “I think I threw up a couple of times. We were supposed to fly out late that morning, so I was panicking, Al was panicking. I literally had to lean on him to walk onto the plane to go home.”

Back in New York, Roberts consulted a doctor, who thought she might have benign paroxysmal positional vertigo (BPPV), a common inner ear disorder where head movement can bring on mild to intense dizziness. “He said there wasn't much he could do for it but suggested something called Cawthorne exercises, which can help alleviate vertigo symptoms,” says Roberts. “I did those for a while, and they seemed to help.”

Cawthorne-Cooksey exercises, named for the two medical consultants who developed them in the 1940s to treat soldiers with balance problems, are eye and head movements that were once commonly used in vestibular rehabilitation (a specialized form of physical therapy) for people with vertigo. Now a head movement called the Epley maneuver is recommended more often.

Roberts—the winner of several Emmy awards for her national and international reporting and recipient of a Peabody Award for the 20/20 special “Say Her Name: Breonna Taylor”—has not had another episode as severe as the one in the Bahamas, but the vertigo continues to come and go. “I deal with it off and on,” she says. “Sometimes it's accompanied by a bit of a migraine, but mild, not intense. For me it's almost a sulfury, grainy feeling in my head. And sometimes I'm looking down and then I look up and feel a swirling, and I think, ‘Oh, I'm coping with that again.’ It may last a week or so and go away. I've learned to deal with it.”

The symptoms Roberts has experienced are more consistent with a condition called vestibular migraine than BPPV, says Kamala Saha, MD, a neurologist in the balance disorders program and Lewis Headache Center at Phoenix's Barrow Neurological Institute, who believes Roberts' 2010 diagnosis of BPPV may not have been accurate. People with vestibular migraine experience dizziness with or without a headache and have other migraine symptoms, such as aura or sensitivity to light and/or sound.

The disorder is usually diagnosed after at least five episodes—lasting from five minutes to 72 hours—of moderate to severe vestibular symptoms, such as vertigo, unsteady gait, and intolerance to head movement. Other criteria for a diagnosis include a history of migraine (with or without an aura) and at least one migraine feature (such as sensitivity to light or sound) with most vestibular episodes, according to the 2022 update in the Journal of Vestibular Disorders.

Far more common in women than in men, vestibular migraine affects up to 3 percent of the population and usually develops before the age of 40. Its cause is not entirely clear but could be a processing problem in the brain, says Amir Kheradmand, MD, associate professor of neurology, neuroscience, and otolaryngology/head and neck surgery at the Johns Hopkins University School of Medicine in Baltimore.

“Vestibular migraine represents a complex network function rather than a specific local issue inside the brain. That's why it's not an easy problem to tackle,” says Dr. Kheradmand, who also is director of research in the neuro-visual and vestibular division at Johns Hopkins. To explain the possible mechanism of vestibular migraine, Dr. Kheradmand compares the brain to a computer that processes and integrates a lot of information, particularly sensory information. It has to understand where the body is relative to its environment and update that information based on changes in eye and head positioning and everything around it. If the brain is overwhelmed, there's a mismatch between sensory demands and the brain's ability to keep up, and the result could be dizziness, disorientation, headaches, and sensitivity to light and sound.

Why one person's brain gets overwhelmed and another person's brain does not may be related to various environmental and genetic factors. “Some genetic predisposition contributes to developing tendencies for migraine and vestibular migraine,” says Dr. Kheradmand. Roberts says one of her siblings has dealt with similar symptoms of vertigo. A 2020 review in Frontiers in Genetics found the prevalence of vestibular migraine among siblings who have the disease to be four to 10 times higher than in the general population. “If people have that predisposition and have high-stress jobs or other lifestyle factors that further sap the brain's processing power, such as working long hours with little sleep, they may be at additional risk. I think it is an underdiagnosed problem that is likely more common than we realize.”

Through the years, Roberts has tracked her episodes to identify and try to avoid triggers. “As a journalist, I always want to get to the root of things, so over time I have made it a habit to observe what causes these episodes,” she says. “I've noticed that long flights, lack of sleep, and alcohol definitely can influence them, as can changes in weather and elevation.

“A few weeks ago I went to Salt Lake City on assignment, and I had to brace myself because I was going to a higher elevation—and sure enough, I did feel something like a migraine,” says Roberts. “And if I've had a very busy week where I've been going out to dinner a lot, staying up late, and having a few drinks, I will often see a little spike. That's when I know I should pull back a bit, drink more water, and get more rest.”

Roberts has been doing exactly what she should be doing, Dr. Saha says. “The more you can identify factors that precede a migraine and control them, the more you will see improvement in vestibular migraine.” When these factors occur simultaneously (high altitude, lack of sleep, dehydration), Dr. Saha adds, the threshold for getting a migraine or vertigo is decreased, and symptoms may be more pronounced. “That's an important consideration for patients in managing the condition.”

As with regular migraine, patterns of vestibular migraine can vary in a person's life. For some it can go away for a while and then return; in others it can fully resolve, Dr. Saha says.

Getting regular sleep, eating healthfully, exercising, reducing stress, staying hydrated, and limiting alcohol and caffeine intake (which are dehydrating) are important ways to manage migraine, says Kristen K. Steenerson, MD, clinical assistant professor of neurology at Stanford University School of Medicine in Palo Alto, CA. She notes, however, that exercise can feel challenging if “moving makes you feel dizzy or nauseated.”

“Being active helps you desensitize and habituate to movement,” explains Dr. Steenerson. “Your doctor or vestibular physical therapist can work with you on desensitization practices, where you move your eyes, head, and body slowly and gradually increase to more exercise over time.”

If and when his patients are able, Dr. Kheradmand suggests that they engage in activities that boost the brain's multitasking skills and ability to shift attention—such as dancing or playing ping-pong. “Fast-paced activities that require hand-and-body coordination train the brain to develop a higher threshold for dizziness,” he says.

Specific exercise-based therapy (vestibular rehabilitation) also has been found to benefit people with vestibular migraine. It could include turning the head from side to side, leading with the eyes (as if watching a tennis match), or walking in a straight line down a hallway while turning the head with each step.

Some medications can ease vestibular migraine symptoms, but traditional migraine drugs, which tend to address pain, may not stop the dizziness, although clinical trials for the antidepressant venlafaxine (Effexor) and the antiseizure drug topiramate (Topamax) have yielded positive results, says Teshamae Monteith, MD, FAAN, associate professor of neurology at the University of Miami Miller School of Medicine. Tricyclic antidepressants such as nortriptyline, as well as a newer generation of antidepressants (selective serotonin reuptake inhibitors)—one of the best-known is fluoxetine (Prozac)—have been shown to help some people with vestibular migraine, although “we do not have systematic studies examining this,” according to Dr. Kheradmand. “But medication alone is not the way to treat vestibular migraine,” he adds. “It needs to be combined with lifestyle interventions and removing triggers.”

Roberts has had recent incidents when she's felt uneasy walking outdoors or had to interrupt a run in the park because she was experiencing dizziness. “I've talked about that on social media because I want to make people aware of it,” she says.

For other people coping with the disorder, Roberts advises listening and responding to physical signals. “Really stay in tune with your body and be aware of what's going on. If something repetitive is happening to you, don't ignore it,” she says.

“Women in particular often suffer in silence. When our family's health is involved, we are right on top of everything,” says Roberts, citing her involvement when her husband was treated for prostate cancer, blood clots, and other conditions. “But when I'm experiencing vertigo, I don't even talk about it, and my family might not know. That's not a good thing.

“Learning to live with it is not the right approach,” Roberts says. “I've never been good at being the patient and taking care of myself, but I realize I need to take charge of my health.”

Different Causes of Dizziness

Vestibular migraine is a common cause of dizziness and vertigo, which are among the most frequently reported symptoms in medicine, affecting between 15 and 35 percent of Americans, according to the Handbook of Clinical Neurology.

Other common causes of dizziness include benign paroxysmal positional vertigo (BPPV), an inner ear disorder caused by particles of calcium carbonate dislodged within the inner ear structures that regulate balance; labyrinthitis or vestibular neuritis, inner ear infections that cause inflammation; and Ménière's disease, a rare inner ear disorder that affects balance and hearing and can, in some cases, cause permanent hearing loss.

“A lot of the symptoms of these conditions overlap, which is partly why it's hard to get an accurate diagnosis of vestibular migraine,” says Kristen K. Steenerson, MD, clinical assistant professor of neurology at Stanford University School of Medicine in Palo Alto, CA.

“Vestibular migraine is diagnosed based on symptoms plus timing,” she says. “If you have a single episode of vertigo that comes on suddenly and gradually goes away and never comes back, it is usually due to an inner ear infection like labyrinthitis or vestibular neuritis.”

For recurring episodes of dizziness or disorientation, the length of the episode can be telling. “Episodes that last just a few seconds to a couple of minutes—perhaps when you roll over in bed or get up from bed—are almost always BPPV,” Dr. Steenerson says. “If the episodes last for several minutes or a few hours or days, without any hearing symptoms, it's likely to be vestibular migraine.” Other clues that it might be vestibular migraine include sensitivity to light or sound and exacerbation of symptoms due to changes in sleep or to stress or exposure to excessive stimulation, says Teshamae Monteith, MD, FAAN, associate professor of neurology at the University of Miami Miller School of Medicine.

Dizziness and nausea that are accompanied by hearing problems such as tinnitus are more likely to be related to Ménière's disease, which is much less common than vestibular migraine, says Dr. Steenerson.