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Vestibular migraine

Carrie Elizabeth Robertson, MD
Section Editor
Jerry W Swanson, MD, MHPE
Deputy Editor
Janet L Wilterdink, MD


Vestibular migraine is a term used to describe episodic vertigo in patients with a history of migraines or with other clinical features of migraine. While an association between episodic vertigo and migraine was noted as long ago as 1873, attempts at a more scientific analysis of this relationship have only begun over the last 20 years [1]. Many reports have documented a relationship between vestibular and migraine disorders, but problems with terminology and spurious correlations have limited progress [2-4].

Alternative terms that have been used more or less synonymously include migraine-associated vertigo, migraine-related vestibulopathy, migrainous vertigo, benign recurrent vertigo, and benign paroxysmal vertigo of childhood, highlight some of the uncertainties surrounding our understanding of this disorder.

Vestibular migraine is considered to be distinct from migraine with brainstem aura (MBA). While vertigo is a common feature of MBA, the diagnostic criteria for MBA require that more than one neurologic symptom of putative brainstem or bilateral cortical origin occurs as part of a headache aura. Patients with vestibular migraine typically do not have other neurologic symptoms and may not even have headache with their attacks of vertigo.

This topic will discuss vestibular migraine. Migraine with brainstem aura (basilar migraine) and other manifestations of migraine are discussed separately. (See "Migraine with brainstem aura (basilar-type migraine)" and "Pathophysiology, clinical manifestations, and diagnosis of migraine in adults".)


A population-based study in Germany, screening a representative sample of the population using the criteria described above, estimated a lifetime prevalence of vestibular migraine of approximately 1 percent [5]. While two-thirds of patients identified as having vestibular migraine had consulted a clinician regarding this problem, only 20 percent were given that diagnosis. Other epidemiology studies report similar statistics [6,7].

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Literature review current through: Nov 2017. | This topic last updated: Aug 10, 2015.
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  1. Liveing E. On Megrim, Sick-Headache, and Some Allied Disorders, Churchill, London 1873.
  2. Sturzenegger MH, Meienberg O. Basilar artery migraine: a follow-up study of 82 cases. Headache 1985; 25:408.
  3. Olsson JE. Neurotologic findings in basilar migraine. Laryngoscope 1991; 101:1.
  4. Kayan A, Hood JD. Neuro-otological manifestations of migraine. Brain 1984; 107 ( Pt 4):1123.
  5. Neuhauser HK, Radtke A, von Brevern M, et al. Migrainous vertigo: prevalence and impact on quality of life. Neurology 2006; 67:1028.
  6. Furman JM, Marcus DA, Balaban CD. Vestibular migraine: clinical aspects and pathophysiology. Lancet Neurol 2013; 12:706.
  7. von Brevern M, Neuhauser H. Epidemiological evidence for a link between vertigo and migraine. J Vestib Res 2011; 21:299.
  8. Johnson GD. Medical management of migraine-related dizziness and vertigo. Laryngoscope 1998; 108:1.
  9. Dieterich M, Brandt T. Episodic vertigo related to migraine (90 cases): vestibular migraine? J Neurol 1999; 246:883.
  10. Cutrer FM, Baloh RW. Migraine-associated dizziness. Headache 1992; 32:300.
  11. Neuhauser H, Leopold M, von Brevern M, et al. The interrelations of migraine, vertigo, and migrainous vertigo. Neurology 2001; 56:436.
  12. Reploeg MD, Goebel JA. Migraine-associated dizziness: patient characteristics and management options. Otol Neurotol 2002; 23:364.
  13. Furman JM, Marcus DA, Balaban CD. Migrainous vertigo: development of a pathogenetic model and structured diagnostic interview. Curr Opin Neurol 2003; 16:5.
  14. SELBY G, LANCE JW. Observations on 500 cases of migraine and allied vascular headache. J Neurol Neurosurg Psychiatry 1960; 23:23.
  15. Kuritzky A, Ziegler DK, Hassanein R. Vertigo, motion sickness and migraine. Headache 1981; 21:227.
  16. Bayazit Y, Yilmaz M, Mumbuç S, Kanlikama M. Assessment of migraine-related cochleovestibular symptoms. Rev Laryngol Otol Rhinol (Bord) 2001; 122:85.
  17. Neuhauser HK, von Brevern M, Radtke A, et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology 2005; 65:898.
  18. Baloh RW. Neurotology of migraine. Headache 1997; 37:615.
  19. Golding JF. Motion sickness susceptibility questionnaire revised and its relationship to other forms of sickness. Brain Res Bull 1998; 47:507.
  20. Aromaa M, Sillanpää ML, Rautava P, Helenius H. Childhood headache at school entry: a controlled clinical study. Neurology 1998; 50:1729.
  21. Murdin L, Chamberlain F, Cheema S, et al. Motion sickness in migraine and vestibular disorders. J Neurol Neurosurg Psychiatry 2015; 86:585.
  22. Toglia JU, Thomas D, Kuritzky A. Common migraine and vestibular function. Electronystagmographic study and pathogenesis. Ann Otol Rhinol Laryngol 1981; 90:267.
  23. Harno H, Hirvonen T, Kaunisto MA, et al. Subclinical vestibulocerebellar dysfunction in migraine with and without aura. Neurology 2003; 61:1748.
  24. Ishizaki K, Mori N, Takeshima T, et al. Static stabilometry in patients with migraine and tension-type headache during a headache-free period. Psychiatry Clin Neurosci 2002; 56:85.
  25. Thakar A, Anjaneyulu C, Deka RC. Vertigo syndromes and mechanisms in migraine. J Laryngol Otol 2001; 115:782.
  26. Celebisoy N, Gökçay F, Sirin H, Biçak N. Migrainous vertigo: clinical, oculographic and posturographic findings. Cephalalgia 2008; 28:72.
  27. von Brevern M, Zeise D, Neuhauser H, et al. Acute migrainous vertigo: clinical and oculographic findings. Brain 2005; 128:365.
  28. Slater R. Benign recurrent vertigo. J Neurol Neurosurg Psychiatry 1979; 42:363.
  29. Moretti G, Manzoni GC, Caffarra P, Parma M. "Benign recurrent vertigo" and its connection with migraine. Headache 1980; 20:344.
  30. Lanzi G, Balottin U, Fazzi E, et al. Benign paroxysmal vertigo of childhood: a long-term follow-up. Cephalalgia 1994; 14:458.
  31. Lipkin AF, Jenkins HA, Coker NJ. Migraine and sudden sensorineural hearing loss. Arch Otolaryngol Head Neck Surg 1987; 113:325.
  32. Viirre ES, Baloh RW. Migraine as a cause of sudden hearing loss. Headache 1996; 36:24.
  33. Oh AK, Lee H, Jen JC, et al. Familial benign recurrent vertigo. Am J Med Genet 2001; 100:287.
  34. Drummond PD. Motion sickness and migraine: optokinetic stimulation increases scalp tenderness, pain sensitivity in the fingers and photophobia. Cephalalgia 2002; 22:117.
  35. Kuritzky A, Toglia UJ, Thomas D. Vestibular function in migraine. Headache 1981; 21:110.
  36. Baloh RW, Yue Q, Furman JM, Nelson SF. Familial episodic ataxia: clinical heterogeneity in four families linked to chromosome 19p. Ann Neurol 1997; 41:8.
  37. Jen J, Kim GW, Baloh RW. Clinical spectrum of episodic ataxia type 2. Neurology 2004; 62:17.
  38. Ophoff RA, Terwindt GM, Vergouwe MN, et al. Familial hemiplegic migraine and episodic ataxia type-2 are caused by mutations in the Ca2+ channel gene CACNL1A4. Cell 1996; 87:543.
  39. Baloh RW, Foster CA, Yue Q, Nelson SF. Familial migraine with vertigo and essential tremor. Neurology 1996; 46:458.
  40. Baloh RW, Jacobson K, Fife T. Familial vestibulopathy: a new dominantly inherited syndrome. Neurology 1994; 44:20.
  41. Radtke A, Lempert T, Gresty MA, et al. Migraine and Ménière's disease: is there a link? Neurology 2002; 59:1700.
  42. Lee H, Lopez I, Ishiyama A, Baloh RW. Can migraine damage the inner ear? Arch Neurol 2000; 57:1631.
  43. von Brevern M, Radtke A, Clarke AH, Lempert T. Migrainous vertigo presenting as episodic positional vertigo. Neurology 2004; 62:469.
  44. Ishiyama A, Jacobson KM, Baloh RW. Migraine and benign positional vertigo. Ann Otol Rhinol Laryngol 2000; 109:377.
  45. Lempert T, Leopold M, von Brevern M, Neuhauser H. Migraine and benign positional vertigo. Ann Otol Rhinol Laryngol 2000; 109:1176.
  46. Seemungal B, Rudge P, Davies R, et al. Three patients with migraine following caloric-induced vestibular stimulation. J Neurol 2006; 253:1000.
  47. Murdin L, Davies RA, Bronstein AM. Vertigo as a migraine trigger. Neurology 2009; 73:638.
  48. Salhofer S, Lieba-Samal D, Freydl E, et al. Migraine and vertigo--a prospective diary study. Cephalalgia 2010; 30:821.
  49. Radtke A, Neuhauser H, von Brevern M, et al. Vestibular migraine--validity of clinical diagnostic criteria. Cephalalgia 2011; 31:906.
  50. Lempert T, Neuhauser H. Epidemiology of vertigo, migraine and vestibular migraine. J Neurol 2009; 256:333.
  51. Cohen JM, Bigal ME, Newman LC. Migraine and vestibular symptoms--identifying clinical features that predict "vestibular migraine". Headache 2011; 51:1393.
  52. Neuhauser H, Lempert T. Vertigo and dizziness related to migraine: a diagnostic challenge. Cephalalgia 2004; 24:83.
  53. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.
  54. Wang CT, Lai MS, Young YH. Relationship between basilar-type migraine and migrainous vertigo. Headache 2009; 49:426.
  55. Teggi R, Colombo B, Bernasconi L, et al. Migrainous vertigo: results of caloric testing and stabilometric findings. Headache 2009; 49:435.
  56. Baier B, Stieber N, Dieterich M. Vestibular-evoked myogenic potentials in vestibular migraine. J Neurol 2009; 256:1447.
  57. Jeong SH, Oh SY, Kim HJ, et al. Vestibular dysfunction in migraine: effects of associated vertigo and motion sickness. J Neurol 2010; 257:905.
  58. Boldingh MI, Ljøstad U, Mygland A, Monstad P. Vestibular sensitivity in vestibular migraine: VEMPs and motion sickness susceptibility. Cephalalgia 2011; 31:1211.
  59. Boismier TE, Disher MJ. Spontaneous vertigo and headache: endolymphatic hydrops or migraine? Ear Nose Throat J 2001; 80:881.
  60. Kim JS. Vertigo and gait ataxia without usual signs of lateral medullary infarction: a clinical variant related to rostral-dorsolateral lesions. Cerebrovasc Dis 2000; 10:471.
  61. Baloh RW. Vertebrobasilar insufficiency and stroke. Otolaryngol Head Neck Surg 1995; 112:114.
  62. Maldonado Fernández M, Birdi JS, Irving GJ, et al. Pharmacological agents for the prevention of vestibular migraine. Cochrane Database Syst Rev 2015; :CD010600.
  63. Evans RW, Baloh RW. Episodic vertigo and migraine. Headache 2001; 41:604.
  64. Neuhauser H, Radtke A, von Brevern M, Lempert T. Zolmitriptan for treatment of migrainous vertigo: a pilot randomized placebo-controlled trial. Neurology 2003; 60:882.
  65. Bikhazi P, Jackson C, Ruckenstein MJ. Efficacy of antimigrainous therapy in the treatment of migraine-associated dizziness. Am J Otol 1997; 18:350.
  66. Baier B, Winkenwerder E, Dieterich M. "Vestibular migraine": effects of prophylactic therapy with various drugs. A retrospective study. J Neurol 2009; 256:436.
  67. Maione A. Migraine-related vertigo: diagnostic criteria and prophylactic treatment. Laryngoscope 2006; 116:1782.
  68. Fotuhi M, Glaun B, Quan SY, Sofare T. Vestibular migraine: a critical review of treatment trials. J Neurol 2009; 256:711.
  69. Marcus DA, Furman JM. Prevention of motion sickness with rizatriptan: a double-blind, placebo-controlled pilot study. Med Sci Monit 2006; 12:PI1.
  70. Mikulec AA, Faraji F, Kinsella LJ. Evaluation of the efficacy of caffeine cessation, nortriptyline, and topiramate therapy in vestibular migraine and complex dizziness of unknown etiology. Am J Otolaryngol 2012; 33:121.
  71. Lepcha A, Amalanathan S, Augustine AM, et al. Flunarizine in the prophylaxis of migrainous vertigo: a randomized controlled trial. Eur Arch Otorhinolaryngol 2014; 271:2931.
  72. Carmona S, Settecase N. Use of topiramate (topamax) in a subgroup of migraine-vertigo patients with auditory symptoms. Ann N Y Acad Sci 2005; 1039:517.
  73. Bisdorff AR. Treatment of migraine related vertigo with lamotrigine an observational study. Bull Soc Sci Med Grand Duche Luxemb 2004; :103.
  74. Gode S, Celebisoy N, Kirazli T, et al. Clinical assessment of topiramate therapy in patients with migrainous vertigo. Headache 2010; 50:77.
  75. Whitney SL, Wrisley DM, Brown KE, Furman JM. Physical therapy for migraine-related vestibulopathy and vestibular dysfunction with history of migraine. Laryngoscope 2000; 110:1528.
  76. Bisdorff AR. Management of vestibular migraine. Ther Adv Neurol Disord 2011; 4:183.
  77. Radtke A, von Brevern M, Neuhauser H, et al. Vestibular migraine: long-term follow-up of clinical symptoms and vestibulo-cochlear findings. Neurology 2012; 79:1607.