Investigators at the University of Pittsburgh, PA, review the latest clinical diagnostic criteria, pathophysiology, and treatment of vestibular migraine. Diagnosis requires all four of the following criteria:
At least 5 episodes with vestibular symptoms lasting between 5min and 72h;
Migraine with or without aura, present or previous history;
One or more migraine features with at least 50% vestibular episodes;
Not explained by another vestibular disorder.
Physical examination is generally normal between episodes. During episodes, nystagmus suggests a central or peripheral vestibular abnormality. Non-paroxysmal positional nystagmus is especially common. Vestibular migraine has a strong female preponderance, up to 5 to 1. Triggers are the same as those for migraine headache, including menstruation, sleep disorder, stress, physical exertion, dehydration, and food and drinks. Related disorders include Meniere’s disease, benign paroxysmal positional vertigo, and anxiety. Treatment includes removal of triggers and pharmacotherapy, similar to that employed for migraine headache. The pathophysiology of vestibular migraine is incompletely understood. [1]
COMMENT. The association of recurrent vertigo with migraine in children was described as benign paroxysmal vertigo in 1964 [2]. In adults, report of this association was delayed until 1984 [3]. Diagnostic criteria for vestibular migraine were published by the International Headache and Barany Societies in 2012. [4]