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Vestibular Migraine: Clinical Features, Triggers

Headache; ePub 2019 Feb 8; Beh, et al

Vestibular migraine (VM) typically affects women in their 40s, with a personal and family history of migraine, according to a recent, single-center study. Researchers conducted a retrospective chart review of 491 patients seen from August 2014 until March 2018 at a tertiary neurology referral center for vestibular disorders. 131 patients (105 women) were identified; mean age of VM onset was 44.3 (±13.7) years. They found:

  • Preceding the onset of vestibular symptoms, most had migraine (57.3%) and motion sickness (61.1%).
  • It was common to have a family history of migraine (50.8%) and episodic vestibular symptoms (28.1%).
  • Common ictal symptoms were triggered (visually induced and head‐motion) and spontaneous vertigo, accompanied by photophobia and phonophobia (118/131 [90.1%] patients), nausea (105/131 [80.2%] patients), aural symptoms (79/131 [60.3%] patients), and headache (65/131 [49.6%] patients).
  • Interictally, many experienced visually induced (116/131 [88.6%] patients), head‐motion (86/131 [65.6%] patients), and persistent (67/131 [51.1%] patients) dizziness.
  • Psychiatric comorbidities include anxiety (92/131 [70.2%] patients), depression (53/131 [40.5%] patients), insomnia (38/131 [29.0%] patients), phobic disorders (15/131 [11.5%] patients), and psychogenic disorders (11/131 [8.4%] patients).


Beh SC, Masrour S, Smith SV, Friedman DI. The spectrum of vestibular migraine: Clinical features, triggers, and examination findings. [Published online ahead of print February 8, 2019]. Headache. doi:10.1111/head.13484.


This study of VM is significant because the investigators had both a large cohort (131 patients) and the capability of describing ictal and interictal characteristics. The authors conclude that VM is typically a disease of women in their 40s, with previous histories of migraine and motion sickness, family histories of migraine, interictal vertigo, and comorbid psychiatric disorders. They conclude that this wide range of symptoms, coupled with the high prevalence of psychiatric comorbidities, may mislead clinicians into attributing VM symptoms to a purely psychiatric etiology. It is, therefore, vital for neurologists to recognize clues that can help them correctly diagnose and treat this common disorder.—Stewart J. Tepper, MD, FAHS, Professor of Neurology, Geisel School of Medicine at Dartmouth, Director, Dartmouth Headache Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH.