Intended for healthcare professionals

Practice Easily missed

Vestibular migraine

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4213 (Published 03 July 2019) Cite this as: BMJ 2019;366:l4213
  1. Vivien Li, neurology specialty registrar1,
  2. Helen McArdle, general practitioner2,
  3. S Anand Trip, consultant neurologist and honorary associate professor1 3
  1. 1National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK
  2. 2Portree Medical Centre, Isle of Skye, Scotland, UK
  3. 3Department of Neurology, Northwick Park Hospital, LNWUH NHS Trust, Harrow, UK
  1. Correspondence to: S A Trip anand.trip{at}nhs.net

What you need to know

  • Consider vestibular migraine in patients with a history of migraine who experience episodic vestibular symptoms and migrainous features, with or without concurrent headache

  • A history of motion sickness or sensitivity can be a helpful diagnostic clue; in contrast, central neurological signs, significant gait ataxia, prominent auditory symptoms, and provocation by particular head movements point to other diagnoses

  • Vestibular migraine adversely affects quality of life and increases the risk of falls. Early diagnosis and treatment with migraine prophylactic agents leads to better clinical outcomes

A 63 year old woman presented to her general practitioner with episodes of severe dizziness, nausea, and vomiting associated with photophobia. On the first attack, symptoms were so severe she was admitted to hospital and underwent neuroimaging to exclude a stroke. Following recurrent episodes, she was given various diagnoses including benign paroxysmal positional vertigo and Ménière’s disease. She had a history of occasional episodic migraine but did not experience episodes of headache with dizziness. Eventually, a diagnosis of vestibular migraine was reached. After commencing topiramate, she has experienced no further attacks.

What is vestibular migraine?

Vestibular migraine (also known as migrainous vertigo) is considered a migraine variant, characterised by a combination of vertigo, dizziness, or balance disturbance with migrainous features.

It is a relatively newly defined entity. In 2012, the Barany Society and International Headache Society released a consensus document on the diagnostic criteria, which has recently been included in the third edition of the International Classification of Headache Disorders (ICHD-3) (box 1). It is currently listed as an appendix, indicating the need for further validation with high level evidence, which may lead to its formal acceptance in future revisions.1 Despite this, we believe it is an important condition to be aware of and recognise, due to its high prevalence (see box 2) and the availability of effective treatments.

Box 1

International Classification of Headache Disorders, third edition (ICHD-3) diagnostic criteria for vestibular migraine1

  1. At …

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