Abstract
About 50% of the vertigo syndromes in childhood are associated with migraine.1 The most frequent type of episodic vertigo in adults is vestibular migraine (VM). Although the clinical characteristics of VM have been known since 1999 from a study on 90 patients2 and confirmed in further clinical and epidemiological studies, the long-lasting controversy surrounding VM ended just recently in 2013. At that time, a consensus paper3 of the International Bárány Society and the International Headache Society finalized the definition of VM that now appears in the third edition of the International Classification of Headache Disorders (ICHD-3). Key symptoms are recurrent attacks of vertigo with various combinations of imbalance of stance and gait, blurred vision, brain stem signs and nausea, and vomiting associated or followed by headache (mostly occipital; absent in ∼ 30%). It is helpful for the diagnosis to know that approximately 60% of patients with VM show mild-to-moderate signs of central ocular motor disorders in the symptom-free interval (e.g., gaze-evoked nystagmus, central positional nystagmus, and impaired smooth pursuit). So far, results of prospective double-blind randomized controlled studies are not available, with the exception of one on flunarizine,4 which was shown to improve the frequency, intensity, and duration of vertigo but not the headache symptoms. Thus, on analogy with migraine without aura, a prophylactic medication is recommended for frequent attacks, for example, β-receptor blockers such as metoprolol retard, topiramate, valproic acid, lamotrigine, or flunarizine.
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