Vertigo’s hidden twin: exploring the vestibular migraine

Vestibular migraine (VM) is a prevalent but frequently underdiagnosed disorder, affecting an estimated 3% of the general population and between 7% to 16% of patients in neurology and neuro-otology clinics. Characterized by episodes of vertigo alongside traditional migraine symptoms, VM often eludes diagnosis due to its variable presentation, which can include dizziness, imbalance, and visual disturbances without the hallmark headache. This variability is thought to arise from complex interactions between vestibular and trigeminal pathways, contributing to a phenomenon called "central sensitization," wherein heightened sensitivity to vestibular stimuli results.

The condition is especially common among women, potentially linked to hormonal changes, and is more frequent in those with coexisting autonomic or connective tissue disorders, which complicates diagnosis further. Treatment approaches for VM include standard migraine prophylactic therapies, with recent studies suggesting promising results for medications targeting the calcitonin gene-related peptide (CGRP) pathway, which can mitigate both migraine and vestibular symptoms.

The significance of VM is underscored by its impact on quality of life, as symptoms often lead to significant disability. Improved diagnostic awareness and recognition of VM as a distinct clinical entity are essential in preventing misdiagnosis as functional or psychological disorders and optimizing care for this population.