Headache

Vestibular Migraine

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Vestibular Migraine

  • Epidemiology
  1. Prevalence: 1-3%
  2. Very common diagnosis in neurotology (tertiary centers)
  3. Common cause of episodic Vertigo in children
  4. More common in women (by 3 fold over men)
  5. Ages affected most commonly: 20 to 50 years old
  • Risk Factors
  1. Family History
  • Diagnosis
  • Criteria ICHD-3
  1. Current or previous history of Migraine Headaches
  2. Vestibular symptom episodes at least 5 times
    1. Vestibular symptoms of a least moderate severity lasting at least 5 minute
    2. Episodes persists for no more than 72 hours
    3. Nystagmus may be horizontal or vertical
  3. More than 50% of the attacks are accompanied by Migraine-type symptoms (at least one of the following)
    1. Migraine Headache (at least 2 of the following)
      1. Unilateral Headache
      2. Pulsating quality
      3. Moderate severity or greater
      4. Worse with routine exertion
    2. Photophobia or Phonophobia
    3. Visual aura
  4. Modifiers
    1. Symptoms are not better accounted for by other neurologic disorder or vestibular disorder
    2. Probable Vestibular Migraine uses the same criteria above
      1. However, diagnosis requires only current Migraine features or prior Migraine history
  • Management
  1. See Vertigo Management
  2. Manage Migraine Headaches
  3. Consider MRI Brain when central Vertigo is considered
  4. Avoid Migraine Headache Triggers
    1. Avoid Tyramine-Vasoactive Amines
    2. Avoid excessive stress
    3. Get adequate rest
  5. Magnesium Supplementation may be effective
  6. Consider Migraine Prophylaxis (e.g. Nortriptyline, Propranolol, Topiramate)
    1. Goal to reduce Vestibular Migraines by 50%
    2. See Migraine Headache Prophylaxis
  • References
  1. Staab (2012) Mayo POIM Conference, Rochester
  2. Muncie (2017) Am Fam Physician 95(3): 154-62 [PubMed]
  3. Rogers (2023) Am Fam Physician 107(5): 514-23 [PubMed]