ABSTRACT
Vestibular migraine (VM) remains an underdiagnosed condition, often mistaken with brainstem aura. VM is defined by recurrent vestibular symptoms in at least 50% of migraine attacks. Diagnosis is established by clinical criteria based on the International Classification of Headache Disorders (ICHD-3). Estimated prevalence of VM is 1 to 2.7% of the adult population. Vestibular symptoms usually appear after the headache. VM pathophysiology remains poorly understood. Vertigo may occur before, during, after the migraine attack, or even independently, and may last seconds to hours or days. Pathophysiological mechanisms for VM are still poorly understood and are usually extrapolated from migraines. Differential diagnoses include Ménière's disease, benign paroxysmal positional vertigo, brainstem aura, transient ischemic attack, persistent perceptual postural vertigo, and episodic type 2 ataxia. Specific treatment recommendations for vestibular migraine are still scarce.
Keywords:
Headache; Migraine Disorders
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Possible mechanisms involved in the pathogenesis of vestibular migraine. Abnormal sensory modulation or integration within the thalamo-cortical network could result in dizziness and spatial disorientation. Hyperactivity within the trigeninovascular system and nociceptive brainstem centers could result in headache. Altered activity in the vestibular system could lead to transient vestibulo-ocular dysfunction or vestibular hypersensitivity associated with migraine features.