The diagnosis of vestibular migraine is primarily based on clinical history, and international guidelines have been developed. The diagnostic criteria of VM are primarily based on the identification of the clinical characteristics outlined in the consensus diagnostic criteria; no particular pattern of neuro-otological abnormalities can be considered as a hallmark of VM. Vestibular and audiological data are divergent across patients and published studies, indicating the variable impact that VM can have on both the peripheral and central audio-vestibular systems. For these reasons, it is necessary to spend time collecting the clinical history of the patient who, however, is not always able to describe his symptoms exactly with the risk of omitting important details for diagnostic purposes. Vestibular testing needs to be performed with the aim of excluding other disorders considered in differential diagnosis. The availability of some instrumental hallmark would be extremely useful, especially in cases where the clinical picture does not fully meet the international diagnostic criteria. Integrating the currently available diagnostic test with some new diagnostic test (fHIT, pupillary nystagmus) such as those using biomarkers would be very useful to create a diagnostic algorithm to diagnose VM supporting the elements obtained from the collection of medical history data.