Recurrent vertigo associated with headaches

A 37 year old woman attended the otolaryngology department with episodes of dizziness (“a feeling of swaying”), occasional rotatory vertigo, and unilateral right sided headaches that usually occurred once a week and had been ongoing for six weeks. Her symptoms could last several hours and were sometimes preceded with the appearance of transient flashing lights. Some episodes were associated with short lasting blurred vision and occasional nausea. Her symptoms were unrelated to head or neck movements but could deteriorate with tiredness, bright light exposure, or high coffee consumption. They would improve after several hours if she could lie down in a dark room. The headaches would usually follow the dizziness/vertigo. There was catamenial exacerbation of her symptoms but no phonophobia, hearing problems, or tinnitus.

She had a history of similar episodes a few years ago that had gradually settled without medication.

Clinical examination was unremarkable. She underwent magnetic resonance imaging (MRI) of the brain and inner ear (fig 1).