Typically, we benefit from our amazing gift of sight, but sometimes what we see can trigger dizziness and vertigo. If you have a vestibular disorder or disease, chances are you’ve experienced visual vertigo or visually induced dizziness. It’s a disorienting and frightening symptom that is common in those with vestibular (or ocular) disorders like vestibular migraine, Meniere’s disease, vestibular neuritis and more.
What is visual vertigo?
Visual vertigo is not a disease. It’s a symptom (or really a group of symptoms) of an underlying neurological, vestibular or ocular dysfunction. This debilitating symptom is vertigo or dizziness provoked by busy visual environments (rich in optic flow). Especially environments that fill your field of vision or those that contain repetitive or moving patterns. Optic flow is basically the streaming movement of images that pass by our peripheral field of vision as we move through an environment. Environments rich in optic flow can spell disaster for vestibular patients.
Environments like grocery stores are tough for those with vestibular disorders because they’re a perfect example of an environment rich in optic flow. The long isles filled with colorful food products create a continuous busy pattern passing by our peripheral field of vision (combined with the bad lighting and shiny floors) making us feel disoriented.
Some people will specifically state that supermarket lighting makes them dizzy, but it’s likely many elements of the environment.
My own visually induced vertigo experience
In the beginning of my vestibular migraine disease, visual vertigo was one of my toughest symptoms. I explain my experience in detail in my drowning in symptoms blog so I’ll be brief here. My brain was in a constant state of confusion when I moved or when I saw something moving. I could not accurately determine if I was moving or if it was the object I was looking at. This caused difficulty looking at the moving water in my swimming pool, trees swaying, television, device scrolling, tracking objects like my dust mop moving over my floors and so much more. I couldn’t walk through a room without feeling a sensation of whirling. Driving was out of the question.
Even well before my vestibular migraine and Meniere’s disease diagnoses, I experienced visually induced vertigo. In my late 20’s, my guy and I were scrolling an online site searching for homes for sale. A few minutes later I had my first ever vertigo experience. I felt hard, room spinning out of nowhere, was immediately nauseous and had to hold onto walls to orient myself as I made my way to the bathroom for relief.
My neurotologist says this symptom (along with my frequent bouts of car sickness) was a precursor and a sign of my movement sensitive, vestibular migraine brain. A neurotologist specializes in the neurology of the ear and skull base (where your inner ear is located) and is an excellent specialist to consider if you’re looking for proper diagnosis and elucidation of dizzy conditions which often present with very similar symptoms.
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What causes visual vertigo?
Vestibular disease and visual dependency are typically the underlying cause of visual vertigo.
There are three systems that communicate with the brain to control our balance.
- Vision- What we see.
- Proprioception- What we feel.
- Vestibular- Our inner ear. Our semicircular canals and otolith organs located in the inner ear detect motion to determine where we are in space.
For those without vestibular dysfunction, the three systems work together to effortlessly determine what is moving, and what is not. We depend on our vestibular systems to help make a distinction between whether we should depend more on our visual or proprioceptive systems at any given moment. This weighting of each system switches throughout our day; if we are walking in the dark, we will use our proprioception more than vision, and if we are walking somewhere new and uneven, we might use our vision to help us predict what’s coming next.
When we have vestibular dysfunction, we cannot rely on the vestibular system, and we tend to
rely too heavily on our visual system. This chronic reliance occurs over time, and we start to lose
“strength” in the vestibular system overall. As this change happens, we are no longer able to
distinguish if we are moving, or if our surroundings are moving.
What are the symptoms? What does visual vertigo feel like?
Here’s a scenario where visual vertigo happens in a ‘normal’ vestibular system: you’re sitting in
your car, parked, in a parking lot. The car next to you reverses, and you suddenly feel as though
you’re moving forward. You may quickly slam on the brakes, but more likely, your vestibular
system will correct for the misinformation and let you know that you are not moving, and you
move on with your day.
In a person with a vestibular disorder, the opposite happens. You see the
car move, your visual system signals to your brain that you are moving, your vestibular system
doesn’t help your brain utilize the signal from your proprioceptive system that you’re still, and
all of a sudden you are dizzy.
While visual vertigo is a symptom of vestibular dysfunction, it carries many other symptoms with it that might include:
- Spinning
- Dizziness
- Nausea and vomiting
- Imbalance
- Ataxia
- Turning pale
- Anxiety
- Sweating
- Fatigue
- Disorientation
- Unsteadiness
- Brain fog
- Salivating
What triggers visual vertigo?
Basically anything that moves or gives the illusion of movement can trigger visual vertigo including, but not limited to:
- Crowded rooms
- Grocery stores
- Busy environments
- Busy fabrics
- Driving
- Flashing lights
- Scrolling
- Tracking objects
- Hotel hallways with busy carpet patterns
- Swaying trees
Dizziness while driving
Many people with visual vertigo experience dizziness while driving. This can increase our anxiety behind the wheel and limit things we need and want to do. Driving in stop and go traffic, on fast highways, through tunnels or even through areas of dappled light can all increase dizziness. Most people have experienced a moment of disorientation while sitting at a stop light when the car next to you begins to slowly creep forward. For a moment if feels as if it’s your own car that’s moving.
When you have vestibular disease, you feel that same disorientation and uncertainty only it doesn’t quickly pass. Movement from your environment can be easily confused with self-movement. A person without vestibular disease adapts quickly to visual movement and easily determines where movement is coming from. But those with vestibular dysfunction fail to adapt as quickly. This slow or lack of adaptation time is what leads to dizziness while driving.
The profound impact on our day to day
Visually induced vertigo can occur when your brain begins to rely too heavily on the information you’re receiving through your eyes. This is called visual dependency. People who have a visual dependency are more likely to develop this visual motion hypersensitivity. Experiencing symptoms that come with visual vertigo like nausea and disorientation are extremely uncomfortable and can lead to avoidance behaviors.
If you have vestibular disease you realize very quickly the activities that increase dizziness and then work to avoid them at all cost. Most people would avoid spinning, loss of balance, sweating, nausea, disorientation etc. if they could. The problem with avoidance behavior when you have vestibular disease is that it weakens proper compensation and strengthens the visual motion hypersensitivity. A better solution is to teach our brains to adapt to triggers we encounter with our eyes rather than to avoid them.
Another problem with avoidance behaviors is that they may potentially lead to diagnosis in psychiatric disorders rather than in neurological or physiological disorders where they belong. It’s time we stop stigmatizing dizzy patients and instead recognize and treat the dysfunction of our balance systems. Just like those with more typical migraine disease may have sensitivity to sound, light, fragrance etc., those with vestibular migraine have sensitivity to movement. Treating the underlying vestibular dysfunction will ease the anxiety and avoidance behaviors that come with that movement sensitivity.
Migraine is a multi-sensory disease that causes multi-sensory symptoms. For some, that includes our complicated balance system.
Our amazing brain
I’m astounded by the amazing ability of our brains to adapt. My recovery from daily dizziness took a painfully long time, but my brain did learn to compensate and adapt for my faulty ears by depending more heavily on my eyes to determine where my body is in space. The benefit of that for me is that I almost never experience dizziness or vertigo attacks anymore when my eyes are open. When attacks do happen, it’s at times when visual input is just too much for my brain to process.
For me, dizziness while driving always comes to mind as it’s a common challenge here in Florida. Downpours are the worst. Hearing the hard rain, seeing the drops slide down my windshield. The windshield wipers swishing back and forth along with the movement of the cars and buildings blurring past my peripheral. My brain just can’t process that much visual input without feeling overwhelmed by the visual motion hypersensitivity.
Along with almost never experiencing dizziness or vertigo with my eyes open, I can also stop a vertigo spin simply by opening my eyes. This is so fascinating to me. It’s a surprising ability that’s resulted from my vestibular dysfunction. Unfortunately, I experience vertigo spins while sleeping multiple times a week. But as soon as I feel the spin simply opening my eyes and looking at a horizontal plane in my room, like the top of the door frame, immediately stops the spin. The way my brain learned to adapt for my faulty vestibular system and rely on my eyes is truly amazing.
What is treatment for visual vertigo?
When you have vestibular dysfunction, brain compensation can be a good thing. But, if your brain is relying too heavily on your eyes and the movement you’re seeing is making you feel dizzy or triggering vertigo, then you know it’s time to seek treatment.
Treating visual vertigo requires treating your underlying disease or vestibular disorder. Proper diagnosis is essential here because while symptoms are similar, there are different treatments for vestibular migraine, vestibular neuritis, Meniere’s disease etc. Once proper diagnosis and treatment are in place this typically improves the reliability of our vestibular and other balance systems.
Are there treatments for visual vertigo that don’t include medication?
Other treatments usually involve avoidance (which we know can also affect us negatively), dark glasses to reduce optic flow and vestibular rehabilitation therapy. Vestibular rehabilitation therapy (VRT) usually includes optokinetic and gaze stabilization exercises that can help desensitize and condition the brain to build up tolerance to triggers that induce visual vertigo, a process called adaptation and habituation. I would likely benefit from optokinetic exercises to help reduce my sensitivity to driving in hard rain since that experience hasn’t happened frequently enough for natural compensation.
If you don’t have access to a vestibular rehabilitation therapist or are interested in learning more, visit The Vertigo Doctor. Dr. Madison Oak is a Vestibular Physical Therapist who helps people with balance disorders return to their desired daily activities. While not meant to replace in person care, she has an amazing social media presence and often reviews gaze stabilization exercises and visual vertigo treatment options. Dr. Oak is also very close to starting a telehealth practice in full force! So soon she will be available to help from the comfort of your own home. She will be licensed in CA, NY, NJ, MD, D.C., VA, WY… and hopefully more states very soon. So keep your eye on her.
I enjoyed reading your article. I too have Vestibular migraines and Menieres Disease since 2018
This is such a well said article! I have felt like this forever but my doctor calls it PPPD. Perceptual, postural, something else, dizziness. I take Venlafaxine for it because she feels it’s anxiety based. Does this seem likely? I’ve noticed that the Venlafaxine makes me dizzier—so helpful! I feel the hardest challenge is driving on sunny days or in winter because the difference of dark and light trees on the roads from the shadows really messes with me.
I did get reading glasses and a much stronger prescription for my regular glasses earlier this year and have noticed a change for the better when watching TV or scrolling on my phone.
Another thing to consider is Binocular Vision Dysfunction or BVD.