What are the key diagnostic criteria for vestibular migraine in adults presenting with vertigo?

Key diagnostic criteria for vestibular migraine in adults presenting with vertigo include:

• Recurrent episodes of dizziness or vertigo lasting between 5 minutes and 72 hours.
• A history of migraine, typically with recurrent headaches, often associated with migrainous features such as photophobia, phonophobia, or visual aura.
• Episodes of vertigo that are not explained by other vestibular disorders such as benign paroxysmal positional vertigo (BPPV), vestibular neuronitis, or central neurological causes.
• Absence of focal neurological deficits or signs suggestive of stroke or other central causes during episodes.
• Clinical assessment should exclude other causes of vertigo, including peripheral vestibular disorders and central neurological conditions, with referral to a balance specialist if diagnosis is uncertain or if red flag symptoms are present.
• Diagnosis is primarily clinical, based on symptom history and exclusion of other causes; there is no definitive diagnostic test.

Because vestibular migraine symptoms can mimic brainstem vascular events, caution is advised in diagnosis, especially in new-onset cases, and hospital admission or specialist referral may be necessary to exclude serious pathology.

Symptomatic treatment is similar to that for standard migraine, although evidence for specific treatments in vestibular migraine is limited.

This approach aligns with UK clinical guidelines emphasizing the importance of symptom duration, migraine history, and exclusion of other causes, while recent literature supports cautious diagnosis due to overlapping features with central causes Beh 2022Eggers & Staab 2024 NICE NG127[Beh 2022][Eggers & Staab 2024].