Vestibular migraine — SCE Neurology MCQ

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HardNeuro-otologyVestibular migraineSCE Neurology

A patient has at least six episodes of spontaneous vertigo lasting two to eight hours. Half are accompanied by photophobia and visual aura; she has a longstanding migraine history. Examination and audiometry are normal between attacks. Which diagnosis best fits?

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Correct answer: D — Vestibular migraine

The best answer is “Vestibular migraine”. Vestibular migraine requires recurrent vestibular episodes lasting five minutes to 72 hours, migraine history and migraine features during at least half of attacks, after reasonable exclusion of another vestibular diagnosis. “Ménière disease” is less appropriate because Ménière disease usually includes fluctuating auditory symptoms and documented sensorineural change “Benign paroxysmal positional vertigo” is less appropriate because BPPV is positionally triggered and typically lasts seconds rather than hours “Persistent postural-perceptual dizziness” is less appropriate because PPPD is persistent on most days rather than discrete symptom-free attacks “Recurrent vestibular neuritis” is less appropriate because vestibular neuritis produces a sustained acute vestibular syndrome rather than recurrent short episodes

Reference: Vestibular migraine: diagnostic criteria update. https://pmc.ncbi.nlm.nih.gov/articles/PMC9249276/