Diagnosis and Treatment in Vestibular Migraine

Vestibular migraine (VM) is the most common cause of recurrent spontaneous vertigo. Inclusion of the diagnostic criteria for VM in the last edition of the International Classification of Headache Disorders published in 2013 promoted the establishment of unity in terminology as well as increasing awareness about VM. The diagnosis of VM is based on clinical history. In studies related to VM, it has been shown that headache and vertigo may not always occur simultaneously, and vertigo may present in different patterns in individual attacks of patients. This variation creates difficulty in the diagnosis of VM. Therefore, the presence of headache should always be questioned in young and middle-aged patients who present with vertigo. Headache that was present previously may have disappeared years ago, hence a detailed patient history is the most essential tool in the diagnosis of VM. There may be some findings showing central and peripheral vestibular involvement in the neurotologic examination during ictal and interictal periods. However, there is no pathognomonic laboratory test; the diagnosis is made clinically. In the differential diagnosis of VM, peripheral vestibular diseases should be excluded, especially Meniere's disease. For treatment, it is important to determine and control the triggers of headache and vertigo, and regulate the patient's lifestyle and nutrition preferences accordingly. Acute and prophylactic medications for migraine might be used, but prospective and randomized controlled studies are necessary in this regard. Vestibular rehabilitation might be especially effective in suppressing symptoms in patients who are highly dependent on environmental and visual stimuli with impaired physiologic adaptation.