Abstract

Migraine is a common clinical syndrome characterized by episodic headache and associated with numerous other neurologic symptoms, including dizziness and vertigo. Migraine may be an important and under-diagnosed cause of various forms of episodic vertigo and there are many studies demonstrating a relationship between migraine disorders and dizziness. However the International Headache Society classification of migraine refers to vertigo as a migrainous symptom only in case of basilar migraine, an infrequent type of migraine that may include vertigo as an aura symptom. The concept of migrainous vertigo (MV) emerged from studies, with various definitions, in which an array of vestibular symptoms were described (i.e., true vertigo attacks, chronic dizziness, positional vertigo, motion-induced dizziness and motion sensitivity). MV patients may have symptoms that overlap with other clinical diagnoses such as Meniere’s disease or benign paroxysmal positioning vertigo, or anxiety associated dizziness adding to diagnostic confusion. It was frequently not possible to make a diagnosis of migraine on the basis of International Headache Society criteria; however the dramatic beneficial response to anti-migraine therapy supported the hypothesis that the vertigo was migrainous in nature. The poor understanding of the underlying pathophysiology of MV and the lack of a biologic marker in most cases compounds the challenge. No universally accepted diagnostic criteria exist for MV, complicating descriptive studies or prospective treatment trials. At present, it is generally accepted that the treatment of MV currently parallels to that of migrainous headache.