Vestibular Migraine

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Mark Obermann - One of the best experts on this subject based on the ideXlab platform.

  • Field testing the ICHD 3 beta diagnostic criteria of Vestibular Migraine (P2.155)
    Neurology, 2018
    Co-Authors: Mark Obermann, Daria Lippegaus, Eva Bock, Zaza Katsarava, Dagny Holle
    Abstract:

    Objective: To determine the diagnostic accuracy of the ICHD3 diagnostic criteria for Vestibular Migraine in a real-world clinical setting. Background: Dizziness and vertigo are common complaints of patients with Migraine. The strong relation of Vestibular symptoms with Migraine lead to the term Vestibular Migraine, but it’s clinical classification is widely discussed. The Barany Society and the International Headache Society together proposed new diagnostic criteria and put them up to be tested in research as well as clinical work. Design/Methods: 130 patients with Vestibular Migraine were re-evaluated by telephone interview with the new ICHD 3 beta diagnostic criteria. The initial diagnosis was made during outpatient consultation in a tertiary dizziness clinic. As control group 30 patients with a clinically confirmed diagnosis of Migraine with or without aura were also re-evaluated using the same questionnaire. The initial diagnosis was made in a tertiary headache center. The Mean age was 46,3 +/− 14 years and 75% of participants were women. Results: The ICHD 3 beta criteria showed a sensitivity of 76.5 % and a specificity of 72.5%. Only 50% of patients had a temporal association of headache and Vestibular symptoms. Most important diagnostic factors were the total amount of endured vertigo attacks (≥ 5), presence of one of the following specific vertigo characteristics (internal, external, spontaneous, visual vertigo, positional vertigo and aggravation by head movement), the presence of headache, at least 2 out of 4 Migraine criteria (unilateral location, pulsating character, moderate to severe pain intensity, aggravation by physical activity), phono-/photophobia, nausea/vomiting, and aura (visual, sensible, aphasia). Conclusions: The sensitivity and specificity of the proposed Vestibular Migraine diagnostic criteria were comparable to other ICHD diagnostic criteria, but may be reduced to a few key criteria. Study Supported by: N/A Disclosure: Dr. Obermann has nothing to disclose. Dr. Lippegaus has nothing to disclose. Dr. Bock has nothing to disclose. Dr. Katsarava has nothing to disclose. Dr. Holle has nothing to disclose.

  • Chronic and Primary Daily Vestibular Migraine - Two New Subtypes of the Disorder (P3.111)
    Neurology, 2018
    Co-Authors: Steffen Naegel, Mark Obermann, Hsin-chieh Chen, H. C. Diener, Christoph Kleinschnitz, Dagny Holle
    Abstract:

    Objective: To characterize chronic courses of Vestibular Migraine. Background: Vestibular Migraine (VM) is a common cause of vertigo affecting approximately 1% of the population. Chronification of Migraine headaches is a well-known condition. Clinical experience has shown, that Vestibular Migraine can also take a chronic course of disease. However, scientific data regarding this topic are sparse. Design/Methods: We retrospectively analyzed records of patients diagnosed with Vestibular Migraine in a tertiary vertigo center (vertigo center Essen) between January 2011 and July 2017. Only patients suffering typical Migraine headaches, fulfilling ICHD3-beta criteria for VM (except duration of Vestibular symptoms), and had vertigo/dizziness on at least 15 days/month were included into the analysis. Patients with concurrent vertigo disorders or psychiatric comorbidities were excluded. Results: Of 12.551 analyzed patient records 69 (67 % female) patients with chronic courses of VM could be certainly identified. Patients age ranged from 15 to 72 years (average 39.5 years). On average vertigo was reported to be first recognized 27.07 month before consultation in the vertigo center. On average patients suffered vertigo on 27.49 +/− SD5,31 days per month. 46.16% patients reported their vertigo to be continuously present. A subset of 24 patients (=35%, age 38.3 years [159–59], 12 female) even reported the vertigo as primary daily (PDVM). Twenty-seven (= 39.13%) suffered typical visual auras at least occasionally. The frequencies of the reported vertigo accompanying symptoms were in expectable rages and in line to headache accompanying symptoms in Migraine. Conclusions: We here for the first time present two new subgroups of patients suffering high frequent vertigo caused by Vestibular Migraine. These preliminary data stress the need to further study different courses of Vestibular Migraine, which here are proposed as chronic Vestibular Migraine and primary persistent Vestibular Migraine. Disclosure: Dr. Naegel has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Diener has nothing to disclose. Dr. Obermann has nothing to disclose. Dr. Kleinschnitz has nothing to disclose. Dr. Holle has nothing to disclose.

  • Treatment Options for Vestibular Migraine
    US Neurology, 2016
    Co-Authors: Steffen Naegel, Manjit Matharu, Mark Obermann
    Abstract:

    Although Vestibular Migraine is a common cause of vertigo, affecting approximately 1% of the Western world’s population, it remains widely under-recognized and is under-diagnosed. Diagnostic criteria for Vestibular Migraine were recently published in collaboration with the International Headache Society and the Bárány-Society. Trials investigating the treatment of Vestibular Migraine are sparse but some are now underway. This review focuses on the treatments options available for Vestibular Migraine, based on the existing evidence base where available. Regarding acute treatments, there are two randomized controlled trials that provide evidence for the use of triptans (zolmitriptan and rizatriptan) for the management of Vestibular Migraine attacks. For prophylactic treatment, the evidence base is largely non-existent, since the only multicenter randomized placebo-controlled trial testing metoprolol versus placebo is still underway. Consequently, the treatment recommendations for the prophylactic treatment of Vestibular Migraine are mainly based on expert opinion and the treatments guidelines for Migraine with and without aura.

  • Central Vestibular System Modulation in Vestibular Migraine - A Voxel-based Morphometry Study (P3.064)
    Neurology, 2015
    Co-Authors: Sebastian Wurthmann, Steffen Naegel, Nina Theysohn, H. C. Diener, Mark Obermann
    Abstract:

    OBJECTIVE: We aimed to identify brain regions altered in Vestibular Migraine in order to evaluate the connection between Migraine and the Vestibular system. BACKGROUND: Vestibular Migraine affects 1[percnt] of the general population and 30-50[percnt] of all Migraine patients describe occasionally associated vertigo or dizziness. DESIGN/METHODS: Seventeen patients with definite Vestibular Migraine were compared to 17 controls using magnetic resonance imaging based voxel-based-morphometry. RESULTS: We found gray matter volume reduction in the superior, inferior and middle (MT/V5) temporal gyrus as well as in the middle cingulate, dorsolateral prefontal, insula, parietal and occipital cortex. A negative correlation of disease duration and GM volume was observed in areas associated with pain and Vestibular processing. Moreover, there was a negative correlation between headache severity and prefrontal cortex volume. CONCLUSIONS: Alterations identified in Vestibular Migraine resemble those previously described for Migraine, but also extent to areas involved in multisensory Vestibular control and central Vestibular compensation possibly representing the pathoanatomic connection between Migraine and the Vestibular system. Study Supported by: none Disclosure: Dr. Wurthmann has nothing to disclose. Dr. Naegel has nothing to disclose. Dr. Theysohn has nothing to disclose. Dr. Diener has received research support from Merck, Pharm-Allergan GmbH, ElectroCore, Amgen, and Novartis. Dr. Obermann has received personal compensation for activities with Biogen Idec, Novartis, Sanofi-Aventis Pharmaceuticals, Pfizer Inc., and Teva Neuroscience.

  • Current Treatment Options in Vestibular Migraine
    Frontiers in neurology, 2014
    Co-Authors: Mark Obermann, Michael Strupp
    Abstract:

    Approximately 1% of the general population in western industrialized countries suffers from Vestibular Migraine. However, it remains widely unknown and often under diagnosed even despite the recently published diagnostic criteria for Vestibular Migraine. Treatment trials that specialize on Vestibular Migraine are scarce and systematic randomized controlled clinical trials are only now emerging. This review summarizes the knowledge on the currently available treatment options that were tested specifically for Vestibular Migraine and gives an evidence-based, informed treatment recommendation with all its limitations. To date only two randomized controlled treatment trials provide limited evidence for the use of rizatriptan and zolmitriptan for the treatment of Vestibular Migraine attacks because of methodological shortcommings. There is an on-going a multicenter randomized placebo-controlled trial testing metoprolol 95 mg vs. placebo (PROVEMIG-trial). Therefore, the therapeutic recommendations for the prophylactic treatment of Vestibular Migraine are currently widely based on the guidelines of Migraine with and without aura as well as expert opinion.

Marianne Dieterich - One of the best experts on this subject based on the ideXlab platform.

  • Vestibular‐Evoked Myogenic Potentials in “Vestibular Migraine” and Menière's Disease
    Annals of the New York Academy of Sciences, 2009
    Co-Authors: Bernhard Baier, Marianne Dieterich
    Abstract:

    Characterizations of the signs and symptoms of "Vestibular Migraine" and of Meniere's disease seem to overlap, suggesting that both diseases might be due to a common peripheral Vestibular dysfunction. Thus, the aim of the present study was to assess Vestibular-evoked myogenic potentials (VEMPs) in both disorders to determine whether there might be an electrophysiological link between the two disorders. The amplitude and latency of VEMPs were measured from the sternocleidomastoid muscle in 63 patients with Vestibular Migraine (median age 47 years, range 24-70 years) and in 16 patients with Meniere's disease (median age 52 years, range 36-72 years), and compared with those of 63 sex- and age-matched healthy controls (median age 46 years, range 17-73 years). In comparison to the controls, 43 of the 63 patients with Vestibular Migraine (68%) and 11 patients with Meniere's disease (69%) had reduced electromyography -corrected VEMP amplitudes, whereas no difference was seen in the latencies. Thus, these data provide evidence that the saccule may be affected in both disorders, indicating a possibly related labyrinthine cause for the pathogenesis of Vestibular Migraine and Meniere's disease.

  • Vestibular evoked myogenic potentials in Vestibular Migraine and meniere s disease a sign of an electrophysiological link
    Annals of the New York Academy of Sciences, 2009
    Co-Authors: Bernhard Baier, Marianne Dieterich
    Abstract:

    Characterizations of the signs and symptoms of "Vestibular Migraine" and of Meniere's disease seem to overlap, suggesting that both diseases might be due to a common peripheral Vestibular dysfunction. Thus, the aim of the present study was to assess Vestibular-evoked myogenic potentials (VEMPs) in both disorders to determine whether there might be an electrophysiological link between the two disorders. The amplitude and latency of VEMPs were measured from the sternocleidomastoid muscle in 63 patients with Vestibular Migraine (median age 47 years, range 24-70 years) and in 16 patients with Meniere's disease (median age 52 years, range 36-72 years), and compared with those of 63 sex- and age-matched healthy controls (median age 46 years, range 17-73 years). In comparison to the controls, 43 of the 63 patients with Vestibular Migraine (68%) and 11 patients with Meniere's disease (69%) had reduced electromyography -corrected VEMP amplitudes, whereas no difference was seen in the latencies. Thus, these data provide evidence that the saccule may be affected in both disorders, indicating a possibly related labyrinthine cause for the pathogenesis of Vestibular Migraine and Meniere's disease.

Fernando Freitas Ganança - One of the best experts on this subject based on the ideXlab platform.

  • Video head impulse test in Vestibular Migraine
    Brazilian journal of otorhinolaryngology, 2020
    Co-Authors: Márcio Cavalcante Salmito, Fernando Freitas Ganança
    Abstract:

    Abstract Introduction Vestibular Migraine as an entity was described in 1999 and its pathophysiology is still not established. Simultaneously with research to better understand Vestibular Migraine, there has been an improvement in Vestibular function assessment. The video-head impulse test is one of the latest tools to evaluate Vestibular function, measuring its Vestibular-ocular reflex gain. Objective To evaluate Vestibular function of Vestibular Migraine patients using video-head impulse test. Methods Cross-sectional case-control study homogeneous by age and gender with Vestibular Migraine patients according to the 2012–2013 Barany Society/International Headache Society diagnostic criteria submitted to video-head impulse test during intercrisis period. Results 31 Vestibular Migraine patients were evaluated with a predominantly female group (90.3%) and mean age of 41 years old. Vestibular function was normal in both patient and control groups. Gain values for horizontal canals were similar between the two groups, but gain values for vertical canals were higher in the group with Vestibular Migraine (p  Conclusions Patients with Vestibular Migraine present normal Vestibular function during intercrisis period when evaluated by video-head impulse test. Vertical canals, however, have higher gains in patients with Vestibular Migraine than in control subjects. Vestibular Migraine patients feel dizziness more often while conducting video-head impulse test.

  • Auditory brainstem function in women with Vestibular Migraine: a controlled study.
    BMC neurology, 2019
    Co-Authors: Alice Andrade Takeuti, Mariana Lopes Fávero, Erica Helena Zaia, Fernando Freitas Ganança
    Abstract:

    Vestibular Migraine (VM) has been recognized as a diagnostic entity over the past three decades. It affects up to 1% of the general population and 7% of patients seen in dizziness clinics. It is still underdiagnosed; consequently, it is important to conduct clinical studies that address diagnostic indicators of VM. The aim of this study was to assess auditory brainstem function in women with Vestibular Migraine using electrophysiological testing, contralateral acoustic reflex and loudness discomfort level. The study group consisted of 29 women with Vestibular Migraine in the interictal period, and the control group comprised 25 healthy women. Auditory brainstem response, frequency following response, binaural interaction component and assessment of contralateral efferent suppression were performed. The threshold of loudness discomfort and the contralateral acoustic reflex were also investigated. The results were compared between the groups. There was a statistically significant difference between the groups in the frequency following response and the loudness discomfort level. The current study suggested that temporal auditory processing and loudness discomfort levels are altered in VM patients during the interictal period, indicating that these measures may be useful as diagnostic criteria.

  • AUDITORY BRAINSTEM FUNCTION IN WOMEN WITH Vestibular Migraine: A CONTROLLED STUDY
    2019
    Co-Authors: Alice Andrade Takeuti, Mariana Lopes Fávero, Erica Helena Zaia, Lilian Lino Salvador, Fernando Freitas Ganança
    Abstract:

    Introduction The link between Vestibular symptoms and Migraine led to the publication of diagnostic criteria of a new disorder named Vestibular Migraine (1,2,3). Even though there is a high frequency of auditory symptoms associated with Migraine, there is not enough information on how it occurs. The psychoacoustic evaluation is normal in most cases, although hearing loss is reported in acute Migraine and Vestibular Migraine situations, probably as results of cochlear vasospasms (3-8). Specific auditory symptoms such as phonophobia, hearing loss and tinnitus suggest impairment of auditory pathways in Migraine cases (2). Auditory brainstem responses can be assessed by electrophysiological exams. Furthermore, brainstem electric disorders could also affect the stapedius muscle reflex or the acoustic reflex due to dysfunctions in higher auditory centers areas or supratentorial structures (9,10). Objective The aim of this study is to assess auditory brainstem auditory function in women with Vestibular Migraine by means of electrophysiological testing and acoustic reflex threshold and to verify the presence of hyperacusis in Vestibular Migraine population, according to loudness discomfort level as defined by to Nields et al. (11). Materials and Methods This case-control study enrolled 29 women with Vestibular Migraine according to the criteria of Neuhauser et al. modified by the Barany Society and International Headache Society (2) in the study group, during their interictal period. The control group was comprised by 25 healthy women matched to the study group according to their age. The subjects in the study group were recruited from the Vestibular Migraine outpatient clinic at the Neurotology service. The control group subjects were volunteers. The following tests were performed in both groups Auditory brainstem response Auditory brainstem response suppression Frequency following response Loudness discomfort level assessment Contralateral acoustic reflex assessment Binaural interaction component A descriptive analysis of the data taking into consideration absolute and relative frequencies, central tendency measures and dispersion measures was performed. For quantitative variables, the standard distribution was verified, and the t-Student test used to compare both groups. The equality of variance was not assumed when homogeneity could not be confirmed within a certain variable. In the association analyses between independent qualitative variables and the outcome measures, the Qui-square test was used. For statistical significance, a descriptive level of 5% (p 0.05). The frequency following response latency of the study group showed average values significantly higher to those for the control group in both ears (p 0.05). Conclusion The current study suggested that the temporal auditory processing as well as the loudness discomfort level are altered in VM patients during the interictal period and may be used as diagnostic criteria III. Topico 16 Migranas incluyendo migrana Vestibular

  • Prophylactic treatment of Vestibular Migraine
    Brazilian journal of otorhinolaryngology, 2016
    Co-Authors: Márcio Cavalcante Salmito, Thais Rodrigues Villa, Juliana Antoniolli Duarte, Lígia Oliveira Golçalves Morganti, Priscila Valéria Caus Brandão, Bruno Higa Nakao, Fernando Freitas Ganança
    Abstract:

    Abstract Introduction Vestibular Migraine (VM) is now accepted as a common cause of episodic vertigo. Treatment of VM involves two situations: the Vestibular symptom attacks and the period between attacks. For the latter, some prophylaxis methods can be used. The current recommendation is to use the same prophylactic drugs used for Migraines, including β-blockers, antidepressants and anticonvulsants. The recent diagnostic definition of Vestibular Migraine makes the number of studies on its treatment scarce. Objective To evaluate the efficacy of prophylactic treatment used in patients from a VM outpatient clinic. Methods Review of medical records from patients with VM according to the criteria of the Barany Society/International Headache Society of 2012 criteria. The drugs used in the treatment and treatment response obtained through the visual analog scale (VAS) for dizziness and headache were assessed. The pre and post-treatment VAS scores were compared (the improvement was evaluated together and individually, per drug used). Associations with clinical subgroups of patients were also assessed. Results Of the 88 assessed records, 47 were eligible. We included patients that met the diagnostic criteria for VM and excluded those whose medical records were illegible and those of patients with other disorders causing dizziness and/or headache that did not meet the 2012 criteria for VM. 80.9% of the patients showed improvement with prophylaxis ( p p p Conclusions Prophylactic medications used to treat VM improve the symptoms of this disease, but there is no statistically significant difference between the responses of prophylactic drugs. The time of Vestibular symptom seems to increase the benefit with prophylactic treatment.

Shin C. Beh - One of the best experts on this subject based on the ideXlab platform.

Michael Strupp - One of the best experts on this subject based on the ideXlab platform.

  • pharmacological agents for the prevention of Vestibular Migraine
    Cochrane Database of Systematic Reviews, 2015
    Co-Authors: Miguel Maldonado Fernandez, Jasminder S Birdi, Greg Irving, Louisa Murdin, Ilkka Kivekas, Michael Strupp
    Abstract:

    Background Vestibular Migraine is a common cause of episodic vertigo. Many preventive treatments have been proposed for this condition, including calcium antagonists, beta-blockers, antidepressants, anticonvulsants, selective 5-HT1 agonists, serotonin antagonists and non-steroidal anti-inflammatory drugs (NSAIDs). Objectives To assess the effects of pharmacological agents for the prevention of Vestibular Migraine. Search methods The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co-ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 5); PubMed; EMBASE; CINAHL; Web of Science; Clinicaltrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 5 June 2015. Selection criteria Randomised controlled trials (RCTs) in adults (over 18 years) with a diagnosis of Vestibular Migraine orprobable Vestibular Migraine according to the Barany Society/International Headache Society (IHS) criteria, treated in any setting, comparing pharmacological treatments used in the prevention of Vestibular Migraine, including beta-blockers, calcium antagonists, anticonvulsants, antidepressants, serotonin antagonists and non-steroidal anti-inflammatory drugs (NSAIDs) against placebo or no treatment. Data collection and analysis We used the standard methodological procedures expected by The Cochrane Collaboration. Main results Our literature search identified 558 reports, however only 11 were sufficiently relevant for further assessment. We excluded two studies because they did not use the IHS diagnostic criteria for Vestibular Migraine. We excluded a further eight studies for various reasons related to their design (e.g. lack of placebo or no treatment comparator), aim (e.g. treatment of Vestibular Migraine rather than prevention) or conduct (e.g. early termination). We identified one ongoing study comparing metoprolol to placebo. The results of this study are awaited; recruitment of the last patient is expected by the end of 2016. Authors' conclusions We found no evidence from RCTs to answer the question set out in the review objectives. This review has identified the need for well-designed randomised controlled trials to answer questions about the efficacy of current and new treatments.

  • The Cochrane Library - Pharmacological agents for the prevention of Vestibular Migraine
    The Cochrane database of systematic reviews, 2015
    Co-Authors: Miguel Maldonado Fernandez, Jasminder S Birdi, Greg Irving, Louisa Murdin, Ilkka Kivekas, Michael Strupp
    Abstract:

    Background Vestibular Migraine is a common cause of episodic vertigo. Many preventive treatments have been proposed for this condition, including calcium antagonists, beta-blockers, antidepressants, anticonvulsants, selective 5-HT1 agonists, serotonin antagonists and non-steroidal anti-inflammatory drugs (NSAIDs). Objectives To assess the effects of pharmacological agents for the prevention of Vestibular Migraine. Search methods The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co-ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 5); PubMed; EMBASE; CINAHL; Web of Science; Clinicaltrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 5 June 2015. Selection criteria Randomised controlled trials (RCTs) in adults (over 18 years) with a diagnosis of Vestibular Migraine orprobable Vestibular Migraine according to the Barany Society/International Headache Society (IHS) criteria, treated in any setting, comparing pharmacological treatments used in the prevention of Vestibular Migraine, including beta-blockers, calcium antagonists, anticonvulsants, antidepressants, serotonin antagonists and non-steroidal anti-inflammatory drugs (NSAIDs) against placebo or no treatment. Data collection and analysis We used the standard methodological procedures expected by The Cochrane Collaboration. Main results Our literature search identified 558 reports, however only 11 were sufficiently relevant for further assessment. We excluded two studies because they did not use the IHS diagnostic criteria for Vestibular Migraine. We excluded a further eight studies for various reasons related to their design (e.g. lack of placebo or no treatment comparator), aim (e.g. treatment of Vestibular Migraine rather than prevention) or conduct (e.g. early termination). We identified one ongoing study comparing metoprolol to placebo. The results of this study are awaited; recruitment of the last patient is expected by the end of 2016. Authors' conclusions We found no evidence from RCTs to answer the question set out in the review objectives. This review has identified the need for well-designed randomised controlled trials to answer questions about the efficacy of current and new treatments.

  • Current Treatment Options in Vestibular Migraine
    Frontiers in neurology, 2014
    Co-Authors: Mark Obermann, Michael Strupp
    Abstract:

    Approximately 1% of the general population in western industrialized countries suffers from Vestibular Migraine. However, it remains widely unknown and often under diagnosed even despite the recently published diagnostic criteria for Vestibular Migraine. Treatment trials that specialize on Vestibular Migraine are scarce and systematic randomized controlled clinical trials are only now emerging. This review summarizes the knowledge on the currently available treatment options that were tested specifically for Vestibular Migraine and gives an evidence-based, informed treatment recommendation with all its limitations. To date only two randomized controlled treatment trials provide limited evidence for the use of rizatriptan and zolmitriptan for the treatment of Vestibular Migraine attacks because of methodological shortcommings. There is an on-going a multicenter randomized placebo-controlled trial testing metoprolol 95 mg vs. placebo (PROVEMIG-trial). Therefore, the therapeutic recommendations for the prophylactic treatment of Vestibular Migraine are currently widely based on the guidelines of Migraine with and without aura as well as expert opinion.

  • Long-Term Changes of Central Ocular Motor Signs in Patients with Vestibular Migraine
    European neurology, 2012
    Co-Authors: Hermann Neugebauer, Christine Adrion, M. Glaser, Michael Strupp
    Abstract:

    Background: A high percentage of patients with Vestibular Migraine (VM) were reported to have central ocular motor dysfunctions (COMD) in the symptom-free interva

  • Chapter 62 - Vestibular Migraine
    Handbook of clinical neurology, 2010
    Co-Authors: Michael Strupp, Maurizio Versino, Thomas Brandt
    Abstract:

    Vestibular Migraine is a chameleon among the episodic vertigo syndromes because considerable variation characterizes its clinical manifestation. The attacks may last from seconds to days. About one-third of patients presents with monosymptomatic attacks of vertigo or dizziness without headache or other migrainous symptoms. During attacks most patients show spontaneous or positional nystagmus and in the attack‐free interval minor ocular motor and Vestibular deficits. Women are significantly more often affected than men. Symptoms may begin at any time in life, with the highest prevalence in young adults and between the ages of 60 and 70. Over the last 10 years Vestibular Migraine has evolved into a medical entity in dizziness units. It is the most common cause of spontaneous recurrent episodic vertigo and accounts for approximately 10% of patients with vertigo and dizziness. Its broad spectrum poses a diagnostic problem of how to rule out Meniere's disease or Vestibular paroxysmia. Vestibular Migraine should be included in the International Headache Classification of Headache Disorders (ICHD) as a subcategory of Migraine. It should, however, be kept separate and distinct from basilar-type Migraine and benign paroxysmal vertigo of childhood. We prefer the term “Vestibular Migraine” to “migrainous vertigo,” because the latter may also refer to various Vestibular and non-Vestibular symptoms. Antimigrainous medication to treat the single attack and to prevent recurring attacks appears to be effective, but the published evidence is weak. A randomized, double-blind, placebo-controlled study is required to evaluate medical treatment of this condition.