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Updated: Sep 12, 2025

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Dizziness: When Is It Migraine, and When Is It Not?

Richard Baron1, Kristen K Steenerson2,3

  • 1Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, USA.

Current Neurology and Neuroscience Reports
|August 5, 2025
PubMed
Summary

Dizziness is common in headache patients, often overlapping with vestibular migraine. This review helps neurologists differentiate vestibular migraine from other vestibular syndromes for accurate diagnosis and treatment.

Keywords:
Benign paroxysmal positional vertigoMal de débarquement syndromeMeniere’s diseaseMotion sicknessPersistent postural-perceptual dizzinessVestibular migraineVestibular neuritis

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Area of Science:

  • Neurology
  • Otolaryngology
  • Neuroscience

Background:

  • Dizziness frequently co-occurs with headache, presenting diagnostic challenges due to overlapping symptoms with various vestibular disorders.
  • Distinguishing vestibular migraine (VM) from other vestibular syndromes is crucial for appropriate patient management.

Purpose of the Study:

  • To provide neurologists with guidance on differentiating dizziness attributed to vestibular migraine from other vestibular syndromes.
  • To review current understanding of VM, including diagnostic criteria, pathophysiology, and treatment options.

Main Methods:

  • Literature review of recent findings on vestibular migraine and related conditions.
  • Analysis of diagnostic tools and clinical examination frameworks for VM.
  • Comparison of VM with other vestibular disorders like BPPV, Meniere's disease, PPPD, and cerebrovascular events.

Main Results:

  • Vestibular migraine is the leading cause of episodic vertigo, with evolving diagnostic criteria and insights into CGRP's role.
  • Emerging diagnostic tools (VM-PATHI) and frameworks (TiTrATE) improve accuracy.
  • Differentiating VM requires thorough clinical history, neurological exam, and understanding of its diverse presentations and comorbidities.

Conclusions:

  • Accurate differentiation of VM from other vestibular causes of dizziness is essential for effective treatment selection.
  • Further research is needed on biomarkers, subtypes, and comparative treatment trials for VM and its mimics.