A new perspective on the clinical features of vestibular migraine

Diagnosis of vestibular migraine (VM) is complicated by its variable clinical presentation and lack of pathognomonic tests.

Two-hundred fifty-eight vestibular attacks of 141 patients were evaluated. In a total of 141 patients, 26% of patients reported no headache. A total of 81% of the patients without headache reported pressure heaviness in the head and head numbness and reported aggravation of these symptoms by routine physical activity. In the group of pVM, 23 patients could not be classified as dVM; they had present or past history of migraine but did not have migrainous characteristics in at least 50% of their vestibular attacks, and 15 of these patients were diagnosed with dVM during follow-up. At least mild central ocular signs were observed in 59 (22%), and impairment in vVOR test (horizontal and/or vertical) was observed in 81 (31%) of 258 vestibular attacks. In vHIT test, 68 (26%) attacks with low VOR gain and refixation saccades and 151 (58%) attacks with normal VOR gain and pathological saccades were detected.

The heterogeneity in clinical and vestibular tests detected in this study, both in patients and in different attacks of the same patients, revealed the importance of taking a detailed history in the diagnosis of VM.