GPAtlas🧭 When to suspect
Suspect vestibular migraine in any patient with recurrent episodes of moderate-to-severe vertigo on a background of current or past migraine.
• The vertigo may be rotational spinning, a rocking or swaying sensation, or feeling 'at sea'.
• Vestibular migraine is the commonest cause of recurrent spontaneous (episodic) vertigo in adults and the second commonest cause of vertigo overall after benign paroxysmal positional vertigo (BPPV).
• Yet it is widely underdiagnosed and frequently mislabelled as BPPV, Ménière's disease or anxiety.
A headache does NOT need to be present during the vertigo for the diagnosis to be made. What matters is a history of migraine plus migrainous features (such as light or sound sensitivity, or visual aura) accompanying the attacks.
| Diagnostic criterion (Bárány/ICHD-3) | What is required |
|---|---|
| A – Episodes | ≥ 5 episodes of vestibular symptoms of moderate or severe intensity, each lasting 5 minutes to 72 hours. |
| B – Migraine history | A current or previous history of migraine, with or without aura. |
| C – Migrainous features | ≥ 1 migraine feature in ≥ 50% of episodes: a migrainous headache (≥ 2 of unilateral, pulsating, moderate/severe, worse with activity), photophobia and phonophobia, or visual aura. |
| D – Exclusion | Not better explained by another vestibular or headache disorder. |
Source: Bárány Society & International Headache Society · BMJ
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