II. Epidemiology
- Prevalence: 1-3%
- Very common diagnosis in neurotology (tertiary centers)
- Common cause of episodic Vertigo in children
- More common in women (by 3 fold over men)
- Ages affected most commonly: 20 to 50 years old
III. Risk Factors
IV. Diagnosis: Criteria ICHD-3
- Current or previous history of Migraine Headaches
- Vestibular symptom episodes at least 5 times
- Vestibular symptoms of a least moderate severity lasting at least 5 minute
- Episodes persists for no more than 72 hours
- Nystagmus may be horizontal or vertical
- More than 50% of the attacks are accompanied by Migraine-type symptoms (at least one of the following)
- Migraine Headache (at least 2 of the following)
- Unilateral Headache
- Pulsating quality
- Moderate severity or greater
- Worse with routine exertion
- Photophobia or Phonophobia
- Visual aura
- Migraine Headache (at least 2 of the following)
- Modifiers
V. Management
- See Vertigo Management
- Manage Migraine Headaches
- Consider MRI Brain when central Vertigo is considered
- Avoid Migraine Headache Triggers
- Avoid Tyramine-Vasoactive Amines
- Avoid excessive stress
- Get adequate rest
- Magnesium Supplementation may be effective
- Consider Migraine Prophylaxis (e.g. Nortriptyline, Propranolol, Topiramate)
- Goal to reduce Vestibular Migraines by 50%
- See Migraine Headache Prophylaxis
VI. References
- Staab (2012) Mayo POIM Conference, Rochester
- Muncie (2017) Am Fam Physician 95(3): 154-62 [PubMed]
- Rogers (2023) Am Fam Physician 107(5): 514-23 [PubMed]