Migraine and Vertigo: Classification, Clinical Features, and Special Treatment Considerations

Abstract

Vestibular migraine is a recognized medical entity in most dizziness units. It accounts for approximately 10% of these ‘dizzy’ patients and is the most common cause of spontaneous episodic vestibular vertigo. In about one third of the patients it is not associated with headache. Vestibular migraine is characterized by an extremely varied manifestation; its attacks last from seconds to days; it can occur at any time in life; and its diagnosis is difficult, especially since it must be differentiated from Meniere's disease, vestibular paroxysmia, and transient ischemic attacks. During the attack pathological spontaneous or positional nystagmus and postural imbalance are found in 70–90%; during the attack-free interval less severe ocular motor signs are found in about 60%. This review delineates the clinical features of vestibular migraine and distinguishes it from motion sickness-like symptoms and nonvestibular dizziness in migraine. Finally, the case is made for including the term ‘vestibular migraine’ in the International Headache Classification as a subcategory of migraine which is distinct from ‘basilar-type migraine’ and ‘benign paroxysmal vertigo of childhood.’