Diagnostic challenges in vestibular migraine: multisensory triggers, neurological-epileptic overlap and the role of functional MRI in oto-neurological practice – A narrative review

Vestibular migraine (VM) poses diagnostic challenges in oto-neurological practice due to its heterogeneous presentation, multisensory triggers, and clinical overlap with epilepsy and other vestibular disorders.1 Current diagnostic criteria, primarily based on subjective symptomatology, are limited in capturing atypical and non-headache-dominant cases.2 Emerging evidence highlights functional MRI (fMRI) as a promising tool for revealing altered connectivity in sensory-processing brain regions, offering potential biomarkers for improved diagnosis.3 This review aims to elucidate multisensory triggers, explore the neurological-epileptic overlap, and assess the diagnostic potential of fMRI in VM. The discussion emphasizes controversies in classification, gaps in current knowledge, and future directions toward establishing imaging-informed diagnostic frameworks.