Clinical Otoneurological Differences between Vestibular Migraine and Probable Vestibular Migraine

Vestibular migraine (VM), and probable VM (VPM), are frequent causes of vertigo. The objective of this study was to establish the prevalence of hearing loss and cochleovestibular paresis in patients with VM and PVM.

Retrospective cohort study of adult patients seen between January 2024 and December 2025, diagnosed with VM or PVM. Demographics, family history of migraine and results of audiometry, videonystagmography (VNG), and Video Head Impulse Test (VHIT) were evaluated. This study was approved by the local Ethics Committee.

A total of 470 patients we included: 53% had VM, 47% PVM. Overall, most were women (79%), average age 51.1 ± 15.2 years. 61% had a hearing test, and 40% had hearing loss. Most were mild-moderate, 51% had unilateral hearing loss and 6.6% had an event of documented cochleovestibular paresis. There were no differences between prevalence or degree of hearing loss or cochleovestibular paresis between VM and PVM. VNG abnormal findings were seen in 88%, most commonly central positional nystagmus, and 56% had an abnormal VHIT. Family history of migraine was greater in the VM group (64% vs. 49%).

Both VM and PVM patients show a high prevalence of hearing loss and vestibular abnormalities, with no significant differences in severity or clinical presentation between groups. These findings support the concept that VM and PVM represent a single pathophysiology continuum, the family history of migraine remains the most reliable clinical differentiator in the diagnostic spectrum. There appears to be no significant differences between VM and PVM with regards to hearing loss or cochleovestibular paresis. The main differences between both groups are family history of migraine.