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Differentiating Vestibular Migraine and Posterior Circulation Transient Ischemic Attack in the Emergency Department:
Sameer Sharif1, Susrutha Kotwal2, Jonathan A Edlow3
1Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
Background:
Vestibular migraine (VM) is a subset of migraine and, as its name suggests, presents with both migrainous and vestibular symptoms. However, a more worrisome diagnosis that can present with similar features is posterior circulation transient ischemic attack (pc-TIA) presenting as episodes of isolated dizziness.
Objectives:
The purpose of this article is to introduce emergency physicians to the diagnostic features of VM focusing on epidemiological context, timing and quality of symptoms that help differentiate vestibular migraine from pc-TIA.
Discussion:
Our comprehensive search of epidemiologic data of VM patients found that they are more likely to be younger and female than patients with pc-TIA. Traditional vascular risk factors and a recent history of head or neck trauma are more common in pc-TIA patients. The onset of dizziness is sudden in pc-TIA with symptoms often lasting less than one hour. Moreover, symptoms tend to be positive in VM versus negative in pc-TIA.
Conclusions:
Medical decision making should be individualized. A new nontriggered episode of isolated dizziness or those with new transient neurological findings should be evaluated for pc-TIA. VM should be considered in younger patients who have had multiple episodes over a greater time period with other migraine-related symptoms.
