# vestibular migraine | Symptoms, Causes, Tests and Treatment | OSANG > Vestibular migraine is a common cause of dizziness, accounting for approximately 7-11% of patients at dizziness clinics. Suspect when vertigo attacks recur in patients w… - Official page: https://osns.co.kr/en/encyclopedia/vestibular-migraine - Organization: OSANG Neurosurgery ## Page content Dizziness ## vestibular migraine Vestibular Migraine · G43.D0 Vestibular migraine (VM) is a disease in which vestibular symptoms (vertigo, postural instability, head movement-induced dizziness, etc.) that last minutes to several hours appear repeatedly in patients who meet the clinical criteria for migraine, and is one of the most common causes of recurrent dizziness. ## At a glance Vestibular migraine is a common cause of dizziness, accounting for approximately 7-11% of patients at dizziness clinics. Suspect when vertigo attacks recur in patients with a history of migraine. Dizziness can last from a few minutes to 72 hours, and may be accompanied by the characteristic symptoms of migraine (headache, hypersensitivity to light and sound, visual auras) or may appear independently. Migraine preventive treatment is also effective in controlling vestibular migraine. - 01Definition and Overview - 02Diagnostic criteria - 03Characteristics of vestibular symptoms - 04Mechanism of occurrence - 05Differentiation from Meniere's disease - 06treatment ## Definition and Overview Vestibular migraine (VM) is a disease in which recurrent vestibular symptoms occur in patients who meet the clinical criteria for migraine. The International Headache Society (IHS) and the Bárány Society jointly established diagnostic criteria, and it is one of the most common causes of recurrent dizziness. Approximately 7-11% of patients at dizziness clinics are diagnosed with vestibular migraine, and approximately 1% of the general population has the disease. It occurs approximately 1.5 to 5 times more often in women than in men, and occurs mainly in people in their 30s to 50s. It is reported that approximately 10-36% of migraine patients are accompanied by vestibular symptoms. ## Diagnostic criteria The criteria for definite vestibular migraine (definite VM) according to the 2012 IHS-Bárány Society joint diagnostic criteria are as follows. A. Current or past history of migraine (with or without aura) according to the International Classification of Headache Disorders. B. Five or more attacks of moderate to severe vestibular symptoms, lasting between 5 minutes and 72 hours. c. More than half of the attacks are accompanied by one or more of the following migraine symptoms: migraine headache, sensitivity to light, sensitivity to sound, or visual auras. D. Not better explained by another vestibular disorder or ICHD diagnosis. Possible vestibular migraine (probable VM) is a case that partially meets the above criteria but does not meet the definitive criteria. ## Characteristics of vestibular symptoms The vestibular symptoms that occur in vestibular migraine are diverse. Spontaneous vertigo is dizziness with a feeling of rotation or linear movement. Positional vertigo occurs when the head position changes and needs to be differentiated from BPPV. Head motion-induced dizziness is dizziness that gets worse when you exercise your head. Visually induced vertigo occurs when exposed to moving objects or complex visual environments. Postural instability and balance disorders are also included. The duration of vestibular symptoms varies from less than 5 minutes to 72 hours, most often minutes to several hours. ## Mechanism of occurrence Although the exact mechanism of vestibular migraine is not known, the neural connection between the pathophysiology of migraine and the vestibular system is understood to be key. Cortical spreading depression (CSD) may involve the vestibular cortex region. CGRP (calcitonin gene-related peptide) is a major neurotransmitter in migraine and is known to act on the vestibular nuclei and inner ear (cochlea). Trigeminal activity appears to influence vestibular signals through the trigemino-vestibular connection. The serotonin system is also involved. Various serotonin receptors are expressed in the vestibular nuclei, so serotonin changes in migraine may cause vestibular symptoms. ## Differentiation from Meniere's disease It is important to differentiate between vestibular migraine and Meniere's disease because they both cause repeated attacks of vertigo. The characteristic findings of Meniere's disease are three symptoms: unilateral sensorineural hearing loss (especially low-frequency hearing loss), tinnitus, and ear fullness. Dizziness usually lasts from tens of minutes to several hours. On the other hand, vestibular migraine is accompanied by migraine symptoms and has no or mild hearing problems. However, since the two diseases can coexist, it is difficult to differentiate them. Hearing test, vestibular evoked muscle potential (VEMP), video head impulse test (vHIT), and caloric test help in differentiation. ## treatment ### Acute Attack Treatment During attacks, triptans such as sumatriptan can be effective for both headaches and dizziness. Antiemetics (metoclopramide) and vestibular suppressants (diazepam, meclizine) are used to relieve acute symptoms. Remain calm during a attack and minimize visual stimulation. ### preventive care If attacks are frequent (more than twice a month), severe, or cause severe functional impairment, begin preventive treatment. Migraine preventive drugs such as topiramate, valproic acid, amitriptyline, and beta blockers (propranolol, metoprolol) are also effective for vestibular migraine. CGRP-targeting monoclonal antibodies (erenumab, galcanezumab) have also been reported to be effective in preventing vestibular migraine. ### Non-pharmacological treatment Vestibular rehabilitation treatment helps improve postural instability and balance disorders between attacks. Lifestyle management (regular sleep, regular eating, restriction of caffeine and alcohol, stress management) contributes to reducing attacks. ## Frequently asked questions ### Q01What is vestibular migraine? This is a disease in which dizziness occurs repeatedly in people with migraines. Dizziness appears in various forms, including vertigo with a spinning sensation, a shaking sensation, and postural instability. Sometimes it comes with a headache, but sometimes dizziness occurs alone. Dizziness can last from a few minutes to dozens of hours, and is often accompanied by sensitivity to light or sound and nausea. ### Q02What is the difference between vestibular migraine and Meniere's disease? Both disorders cause recurrent attacks of vertigo and can be difficult to differentiate. Meniere's disease typically presents with hearing loss in one ear, tinnitus, and aural fullness (a feeling of fullness in the ear). Vestibular migraine occurs when there is a history of migraine, and migraine symptoms (headache, hypersensitivity to light and sound, visual auras) are often associated with dizziness. For accurate differentiation, a hearing test and joint consultation with a neurologist or otolaryngologist are required. ### Q03How long does dizziness from vestibular migraine last? The duration of vestibular migraine dizziness can vary widely, from a few minutes to 72 hours. It most often lasts minutes to hours, but may last a day or more. Normal or mild postural instability remains between attacks. In many cases, dizziness becomes worse when moving the head or sensitivity to visual stimuli (moving objects, complex patterns). Attack frequency varies greatly from person to person and can range from several times a month to several times a year. ### Q04How is vestibular migraine diagnosed? It is diagnosed according to the joint diagnostic criteria of the International Headache Society and the Bárány Society in 2012. You must have a history of migraine, have recurring vestibular symptoms, and at least one of the migraine symptoms (headache, photophobia, visual aura) must appear together when vestibular symptoms occur. Other vestibular disorders or secondary causes must first be ruled out. A specific diagnosis may require hearing tests, vestibular function tests, and brain MRI. ### Q05Is vestibular migraine treatable? Yes, the response to treatment is relatively good. Acute treatment for attacks includes triptan migraine drugs, antiemetics, and vestibular suppressants. If attacks recur frequently, begin preventive treatment. Migraine preventive medications (topiramate, valproic acid, amitriptyline, beta blockers, etc.) are also effectively used for vestibular migraine. Lifestyle management (regular sleep, eating, limiting caffeine and alcohol, and stress management) is also important in reducing attacks. ### Q06Can vestibular migraines lead to PPPD? Yes, vestibular migraine can be a trigger of persistent postural dizziness (PPPD). If dizziness becomes chronic after a vestibular migraine attack or if dizziness persists in certain situations (crowded places, patterns, movement), PPPD should be considered as well. Since the two diseases can coexist, accurate diagnosis and treatment tailored to each disease are required. ## Related articles - Bilateral vestibulopathy - Post-disembarkation syndrome - motion sickness - Superior semicircular canal dehiscence syndrome This article provides general medical information and does not replace an individual diagnosis or treatment plan. 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