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The challenge of vestibular migraine

Sargent, Eric W.

Current Opinion in Otolaryngology & Head and Neck Surgery: October 2013 - Volume 21 - Issue 5 - p 473–479
doi: 10.1097/MOO.0b013e3283648682

Purpose of review Migraine is a common illness and migraine-related dizziness occurs in up to 3% of the population. Because the diagnosis is controversial and may be difficult, many patients go undiagnosed and untreated. This review summarizes current understanding of the taxonomy and diagnosis of vestibular migraine, the relation of vestibular migraine to labyrinthine disease, and the treatment of the condition in adults and children.

Recent findings The categories of migraine accepted by the International Headache Society do not reflect the complex presentations of patients suspected of having vestibular migraine. In clinical practice and research, criteria are increasingly accepted that divide patients suspected of vestibular migraine into ‘definite vestibular migraine’ and ‘probable vestibular migraine.’ Because vertigo itself may trigger migraine, patients with vestibular migraine should be suspected of having vestibular end-organ disease until proven otherwise. Treatment remains controversial because of a notable lack of randomized controlled studies of vestibular migraine treatment.

Summary For now, the best strategy for the treatment of suspected vestibular migraine patients is dietary/lifestyle modification, antinausea/antiemetics for acute vertigo, and preventive medication for patients who have continued disruptive symptoms. Patients with vestibular migraine should be monitored regularly for the development of latent audiovestibular end-organ disease.

Michigan Ear Institute, Farmington Hills, Michigan, USA

Correspondence to Eric W. Sargent, MD, FACS, Michigan Ear Institute. 30055 Northwestern Highway, #101, Farmington Hills, MI 48334, USA. Tel: +1 248 865 4444; fax: +1 248 865 6161; e-mail:

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins