Vestibular migraine: Diagnosis, pathophysiology, therapy

Vestibular migraine (VM) is the most common cause of spontaneous episodic vestibular vertigo. Although VM is a well-recognized entity in specialized dizziness units, it is still underdiagnosed by general practitioners and neurologists. The main reasons for this are the inconsistent diagnostic criteria and the heterogeneous clinical presentation of VM ("a chameleon among the episodic vertigo syndromes"). Moreover, it is sometimes quite difficult to differentiate VM from other vertigo syndromes like Meniere's disease or vestibular paroxysmia, or from non-vestibular dizziness complaints. Important criteria include a family history of migraine, the varying duration of the attacks (lasting generally for minutes up to hours) with unsteadiness of gait and increased eye movement disorders (also observed in the attack-free interval in 60% of the patients), as well as the absence of headache in ca. 30%. Prophylactic treatment of VM is effective.