Vestibular Migraine

Vestibular migraine (VM) is one of the causes of episodic vertigo and is defined as the coexistence of dizziness or vertigo with migraine. Although its diagnostic criteria are clearly established, VM is often confused with other causes of recurrent vertigo and the diagnostic methods and laboratory tests are still unclear. Episodic spontaneous vertigo or positional vertigo is most commonly seen, and headaches may occur at different times than vertigo attacks in patients. The pathophysiology of VM has not been clearly demonstrated. Various mechanisms such as vestibulo-thalamo-cortical dysfunction and multimodal sensory integration have been discussed. One of the major challenges in the diagnosis of VM is to differentiate it from Meniere’s disease (MD), especially in the early stages. Various treatment suggestions, and recently calcitonin gene-related peptide (CGRP) inhibitors such as erenumab, fremanezumab, have been proposed as a prophylactic treatment. This chapter reviews the current literature on the diagnosis, differential diagnosis, pathophysiology, and treatment options for this disorder.