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Update on diagnosis and differential diagnosis of vestibular migraine

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Abstract

Background

Vestibular migraine (VM) is considered the most common cause of spontaneous episodic vertigo and the second most common cause of vertigo. However, without a biomarker or a complete understanding of the pathophysiology, VM remains underrecognized and underdiagnosed. Therefore, definite diagnostic criteria are urgently needed. Meanwhile, VM should be clearly differentiated from other similar diseases. This paper may help clinicians improve the diagnostic rate of VM and reduce the rate of misdiagnosis. A PubMed search was performed using the following terms: vestibular migraine, migraine-associated vertigo/dizziness, migraine-related vertigo, migraine-related vestibulopathy, benign recurrent vertigo, vertiginous migraine, migraine, headache, vertigo, dizziness, and diagnosis. This paper also summarizes the diagnostic criteria and differential diagnoses of VM. The diagnosis of VM is based on the symptoms, degree, frequency, and duration of the vestibular episodes, a history of migraine, and the temporal association of migraine symptoms with vestibular episodes in at least 50% of cases, while ruling out what may be due to other reasons. In addition to vestibular symptoms and migraine, transient auditory symptoms, nausea, vomiting, and susceptibility to motion sickness may also be associated with VM. Thus, VM should be differentiated from other diseases such as Meniere’s disease, benign paroxysmal positional vertigo, migraine with brainstem aura, vestibular neuritis, posterior circulation ischemia, multiple lacunar infarction, vestibular paroxysmia, motion sickness, and episodic ataxia type 2.

Conclusion

Only if the diagnostic criteria of VM and differential diagnosis can be mastered clearly, we can make a definite diagnosis and treat patients properly.

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Abbreviations

VM:

Vestibular migraine

IHS:

The International Headache Society

ICHD-3:

The International Classification of Headache Disorders, 3rd Edition

MD:

Meniere’s disease

EcochG:

Abnormal electrocochleography

vHIT:

Video head impulse test

BPPV:

Benign paroxysmal positional vertigo

MBA:

Migraine with brainstem aura

VN:

Vestibular neuritis

PCI:

Posterior circulation ischemia

MRI:

Magnetic resonance imaging

fMRI:

Functional magnetic resonance imaging

FLAIR:

Fluid-attenuated inversion recovery

ALFF:

Amplitude of low-frequency fluctuation

FC:

Functional connectivity

MLI:

Multiple lacunar infarctions

VP:

Vestibular paroxysmia

MoS:

Motion sickness

EA2:

Episodic ataxia type 2

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Authors and Affiliations

  1. Zhujiang Hospital (The Second School of Clinical Medicine), Southern Medical University, Guangzhou, 510515, Guangdong, China

    Youjin Shen & Xiaokun Qi

  2. Department of Neurology, Deqing County People’s Hospital, Zhaoqing, 526600, Guangdong, China

    Youjin Shen

  3. Department of Neurology, The Sixth Medical Center of PLA of Chinese General Hospital, Beijing, 100048, China

    Xiaokun Qi

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Correspondence to Youjin Shen.

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Shen, Y., Qi, X. Update on diagnosis and differential diagnosis of vestibular migraine. Neurol Sci 43, 1659–1666 (2022). https://doi.org/10.1007/s10072-022-05872-9

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