Updated on 05/01/2024
Vestibular migraine (VM), also called migrainous vertigo, is a type of migraine. It is manifested by the presence of dizziness, lightheadedness or balance disorders in addition to the features of migraine headache. It is a headache type defined relatively recently. The person should have past or newly diagnosed migraine, manifesting with or without aura. Vestibular signs last between 5 minutes and 72 hours and are moderate or severe in severity. Headache is unilateral, throbbing, moderate or severe and increases with bodily movement. It is accompanied by sensitivity to light and sound and could have a visual aura.
Annual incidence is between 0.9% and 2.7%. The average age of onset is 23 - 40.9 years. Observed to be more common in women.
VM is a clinical diagnosis. If the person has a history of migraine and recurrent vestibular findings, the diagnosis of VM can be made after other causes are excluded. Headache need not be observed at the time of vestibular signs. However, the variability of the accompanying findings and the duration of the attack, as well as the overlap of the findings with other episodic dizziness, render the diagnosis of VM difficult.
The quality of life of people with VM is lower than that of the normal population. 40-60% of people experience loss of school day or work, 34-46% cannot perform their daily tasks, 52% fall once in 5 years, and 23% apply to the polyclinic or emergency service. In addition, when misdiagnosed, vestibular suppressive drugs may be used unnecessarily. Anxiety and depression are significantly higher in VM patients.
Brain imaging findings should be normal in the VM. When the patient first presents with a vertigo attack, posterior stroke is the most important disease in the differential diagnosis and brain imaging should be performed. Other diseases included in the differential diagnosis are Meniere's Disease and benign positional vertigo.
First of all, avoidance of triggers, drug therapy and vestibular rehabilitation are recommended.
Vivien Li et al. Vestibular migraine.
BMJ 2019;366:l4213 doi: 10.1136/bmj.l4213