Vestibular Migraine and Facial Paresthesia
Yes, vestibular migraine can present with pins and needles (paresthesia) of the face, as sensory aura symptoms including facial paresthesia are recognized migraine features that can occur with vestibular migraine episodes. 1, 2
Understanding Sensory Symptoms in Vestibular Migraine
Sensory Aura as a Migraine Feature
Pins and needles (paresthesia) are explicitly recognized as positive aura symptoms in migraine, including when they occur in the context of vestibular migraine. 1
Unilateral paresthesia and numbness affecting the face or arm are classic sensory aura symptoms that typically spread gradually, affecting approximately 31% of individuals who experience aura symptoms. 2
These sensory symptoms can occur before, during, or after the vestibular symptoms and headache phase, and may be predominantly unilateral. 2
How This Fits Within Vestibular Migraine Criteria
For vestibular migraine diagnosis, patients need migraine features present in at least 50% of their vestibular episodes, which can include visual aura, photophobia, phonophobia, or headache characteristics. 3, 4
Sensory aura symptoms like facial paresthesia qualify as migraine features that support the diagnosis of vestibular migraine, though visual auras are more commonly emphasized in the diagnostic criteria. 1, 3
The Barany Society criteria specifically note that different symptoms may occur during different episodes, and one symptom is sufficient during a single episode. 1
Clinical Approach to Facial Paresthesia in Vestibular Migraine
Confirming the Migraine Connection
Look for the characteristic gradual spread of paresthesia over at least 5 minutes, with symptoms lasting 5-60 minutes and completely resolving. 1, 2
Document whether the facial paresthesia occurs alongside other migraine features such as headache (one-sided, pulsating, moderate-to-severe intensity), photophobia, phonophobia, nausea, or visual aura. 2, 3
Verify that the paresthesia accompanies or follows vestibular symptoms (vertigo, unsteadiness, balance disturbance) that last 5 minutes to 72 hours. 3, 4
Critical Red Flags to Exclude
Loss of consciousness is never a symptom of migraine or vestibular migraine and demands immediate evaluation for alternative diagnoses. 2, 3
Persistent neurological deficits that do not completely resolve suggest alternative diagnoses (stroke, TIA, structural lesions) and require urgent neuroimaging. 2
Physical examination must exclude other causes, which is mandatory to rule out secondary disorders. 2
Common Pitfalls
Do not dismiss facial paresthesia as unrelated to vestibular migraine simply because it is not the most commonly reported symptom—sensory auras are well-recognized migraine features. 1, 2
Avoid over-reliance on visual aura as the only acceptable aura type; while visual auras are emphasized in vestibular migraine criteria because of their specificity, sensory symptoms like paresthesia are equally valid migraine features. 1, 2
Remember that approximately one-third of vestibular migraine patients present with monosymptomatic attacks without headache, so the absence of headache during a particular episode does not exclude the diagnosis. 5
Documentation Strategy
Track whether facial paresthesia occurs in at least 50% of vestibular episodes, as this temporal association strengthens the vestibular migraine diagnosis. 3, 4
Use a headache diary to document the relationship between vestibular symptoms, facial paresthesia, and other migraine features across multiple episodes. 2
Ensure at least 5 episodes meeting criteria are documented before confirming the diagnosis of definite vestibular migraine. 1, 4