Decoding vestibular migraine for easier diagnosis


  • Anoop C. Vazhipokkil Department of ENT, Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
  • Ashwini Shenoy Department of ENT, Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India



Vestibular migraine, Migrainous vertigo


Background: Due to the absence of a unified set of diagnostic criteria, vestibular migraine is always an underdiagnosed entity. This study was undertaken to find specific pointers in the diagnostic protocol which can help in diagnosing vestibular migraine and also to assess our treatment module for vestibular migraine.

Methods: An elaborate proforma was prepared for evaluating each patient at our vertigo clinic for a time period of two years. A detailed history is followed by general examination, ENT examination, specific tests for eyes, tests for vestibulospinal tract, and also a few more tests such as Doppler, pure tone audiogram, ECHO etc. when the diagnosis was in doubt. A total of 206 patients were evaluated. Vestibular migraine cases were started on our drug regimen of Tab flunarizine once daily and subjected two follow ups (at 4 weeks and 12 weeks).  

Results: Total of 20 patients (9.7%) diagnosed as vestibular migraine. There was a slight preponderance to female population. A positive history of recurrent headache and neck pain were definitive clinchers in diagnosing vestibular migraine. All 20 patients had alleviation of symptoms with regards to severity and frequency of episodes.

Conclusions: Detailed history and elaborate vestibular examination alone is necessary for diagnosing vestibular migraine. Flunarizine regimen for a period of 3 months is found to be effective in relieving the symptoms. Adjuvant vestibular rehabilitation exercises mandatory for total alleviation of symptoms.


Pressman A, Jacobson A, Eguilos R, Gelfand A, Huynh C, Hamilton L, et al. Prevalence of migraine in a diverse community-electronic methods for migraine ascertainment in a large integrated health plan. Cephalalgia. 2016;36:325–34.

Burstein R, Noseda, R, Borsook D. Migraine: Multiple Processes, Complex Pathophysiology. J Neurosci. 2015;35(17):6619–29.

Stovner L, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, et al. The global burden of headache: A documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27:193–210.

Cutrer FM, Baloh RW. Migraine-associated dizziness. Headache. 1992;32(6):300-4.

Furman JM, Marcus DA, Balaban CD. Vestibular migraine: clinical aspects and pathophysiology. Lancet Neurol. 2013;12:706–15.

Neuhauser HK, von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology. 2005;65(6):898–904.

Kayan A, Hood JD. Neuro-otological manifestations of migraine. Brain. 1984;107(4):1123–42.

Dieterich M, Brandt T. Episodic vertigo related to migraine (90 cases): vestibular migraine? J Neurol. 1999;246(10):883-92.

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition (beta version) Cephalalgia. 2013;33(9):629–808.

Sohn JH. Recent Advances in the Understanding of Vestibular Migraine. Behav Neurol. 2016;2016:1801845.

Dieterich M, Obermann M, Celebisoy N. Vestibular migraine: the most frequent entity of episodic vertigo. J Neurol. 2016;263(1):82-9.

Geser R, Straumann D. Referral and Final Diagnoses of Patients Assessed in an Academic Vertigo Center. Frontiers Neurol. 2012;3:169.

Neuhauser H, Leopold M, von Brevern M, Arnold G, Lempert T. The interrelations of migraine, vertigo and migrainous vertigo. Neurology. 2001;56:436–41.

Vukovic V, Plavec D, Galinovic I, Lovrencić-Huzjan A, Budisić M, Demarin V. Prevalence of vertigo, dizziness, and migrainous vertigo in patients with migraine. Headache. 2007;47:1427–35.

Stolte B, Holle D, Naegel S, Diener HC, Obermann M. Vestibular migraine. Cephalalgia. 2015;35(3):262-70.

Van Ombergen A, Van Rompaey V, Van de Heyning P, Wuyts F. Vestibular migraine in an otolaryngology clinic: prevalence, associated symptoms, and prophylactic medication effectiveness. Otol Neurotol. 2015;36(1):133-8.

Verspeelt J, De Locht P, Amery WK. Postmarketing study of the use of flunarizine in vestibular vertigo and in migraine. Eur J Clin Pharmacol. 1996;51:15–22.

de Bock GH, Eelhart J, van Marwijk HW, Tromp TP, Springer MP. A postmarketing study of flunarizine in migraine and vertigo. Pharm World Sci. 1997;19(6):269-74.

Vitkovic J, Winoto A, Rance G, Dowell R, Paine M. Vestibular rehabilitation outcomes in patients with and without vestibular migraine. J Neurol. 2013;260(12):3039-48.

Jönsson R, Sixt E, Landahl S, Rosenhall U. Prevalence of dizziness and vertigo in an urban elderly population. J Vestib Res. 2004;14(1):47-52.






Original Research Articles