A retrospective study was conducted on 90 patients with episodic
vertigo that could be related to
migraine as the most probable pathomechanism. Since the majority of the patients did not fulfill the criteria of the International
Headache Society (IHS) for
basilar migraine, the diagnosis was substantiated by disease course, medical efficacy in treating (
ergotamines) and preventing (
metoprolol,
flunarizine) attacks, ocular motor abnormalities in the symptom-free interval, and careful exclusion of the most relevant differential diagnoses, such as
transient ischemic attacks, Menière's disease, and vestibular paroxysmia. The following clinical features were elaborated. The initial manifestation could occur at any time throughout life, with a peak in the fourth decade in men and a "plateau" between the third and fifth decades in women. The duration of rotational (78%) and/or to-and-fro
vertigo (38%) could last from a few seconds to several hours or, less frequently, even days; duration of a few minutes or of several hours was most frequent. Monosymptomatic audiovestibular attacks (78%) occurred as
vertigo associated with auditory symptoms in only 16%.
Vertigo was not associated with
headache in 32% of the patients. In the symptom-free interval 66% of the patients showed mild central ocular motor signs such as vertical (48%) and/or horizontal (22%) saccadic pursuit, gaze-evoked nystagmus (27%), moderate positional nystagmus (11%), and spontaneous nystagmus (11%). Combinations with other forms of
migraine were found in 52%. Thus,
migraine is a relevant differential diagnosis for episodic
vertigo. According to the criteria of the IHS, only 7.8% of these patients would be diagnosed as having
basilar migraine. However, to ensure that at least those presenting with monosymptomatic episodic
vertigo (78% in our study) receive effective treatment, we propose the use of the more appropriate term "vestibular
migraine."