[Vestibular migraine]

Abstract

Vestibular migraine (VM) presents with attacks of spontaneous or positional vertigo lasting seconds to days. Headaches are often absent during acute attacks, but other symptoms of migraine, such as photophobia or auras may be present. Like migraine headaches VM triggers may include stress, sleep deprivation and hormonal changes. During acute attacks there may be central spontaneous or positional nystagmus and, less commonly, unilateral vestibular hypofunction. In the symptom-free interval vestibular testing shows mostly minor and non-specific findings. The pathogenesis of VM is uncertain but migraine mechanisms may interfere with the vestibular system at the level of the labyrinth, brainstem and cerebral cortex. Treatment includes vestibular suppressants for acute attacks and migraine prophylaxis for patients with frequent recurrences. Avoidance of triggers, stress management and biofeedback may also play a role. However, treatment efficacy has not been validated by properly controlled clinical trials. VM is not included in the 2004 International Headache Society Classification, where basilar-type migraine must have at least two posterior circulation manifestations so that isolated vertigo would not satisfy this criterion.