Vestibular migraine presents with attacks of spontaneous or positional vertigo, head motion–induced vertigo, and visual vertigo lasting 5 minutes to 3 days. The diagnosis requires a history of migraine, temporal association of migraine symptoms with vertigo attacks, and exclusion of other causes. Because headache is often absent during acute attacks, other migraine features such as photophobia or auras have to be specifically inquired about. The pathophysiology of vestibular migraine is unknown, but several mechanisms link the trigeminal system, which is activated during migraine attacks, and the vestibular system. Treatment includes antiemetics for severe acute attacks, pharmacological migraine prophylaxis, and lifestyle changes.
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• Vestibular migraine is the most common cause of spontaneous recurrent vertigo.
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• Diagnostic criteria have been developed by an international group of headache and dizziness experts.
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• Vestibular findings during the asymptomatic interval are usually mild and nonspecific.
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• As high-quality therapeutic trials are lacking, treatment is targeted at the underlying migraine.
Historical note and terminology
The combination of headache, vertigo, nausea, and visual disturbances was described by the Greek physician Aretaeus of Cappadocia almost 2000 years ago (25). That migraine may present with attacks of vertigo has been recognized from the early days of neurology (41). Starting with Kayan and Hood’s classical paper, the clinical features of vestibular migraine have been well elucidated in several large case series (29; 19; 12; 21; 51). Various terms have been used to designate vertigo caused by a migraine mechanism, including “migraine-associated vertigo,” “migraine-associated dizziness,” “migraine-related vestibulopathy,” “migrainous vertigo,” and “benign recurrent vertigo.” “Vestibular migraine” has been convincingly advocated as a term that stresses the particular vestibular manifestation of migraine and, thus, best avoids confounding with nonvestibular dizziness associated with migraine. Therefore, the International Headache Society and the Bárány Society, which represents the international neurootological community, have opted for the term “vestibular migraine” in their consensus paper on the classification of the disorder (39).