Abstract
Vestibular migraine presents with attacks of spontaneous or positional vertigo, head
motion-induced vertigo, and visual vertigo lasting 5 minutes to 3 days. The recent
classification of vestibular migraine, jointly proposed by the Bárány Society and
the International Headache Society, allows identification of vestibular migraine and
probable vestibular migraine based on explicit criteria. The diagnosis is based on
symptom type, severity and duration, 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. During acute attacks, one may find
central spontaneous or positional nystagmus, and less commonly, unilateral vestibular
hypofunction. In the symptom-free interval, vestibular testing adds little to the
diagnosis as findings are mostly minor and nonspecific. 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.
Keywords
migraine - vestibular - vertigo - dizziness
