Vestibular Migraine-A Diagnostic Dilemma (A Case Report with Review of Literature)

Vestibular migraine has been classified as a specific entity in which vestibular symptomatology presents as part of a migrainous disorder. New and appropriate diagnostic criteria have been proposed by the Barany and International Headache Societies [1]. The diagnosis of vestibular migraine isdetermined on the basis of the patient history and the exclusion of other causes of vertigo [2]. We present a case of vestibular migraine, which no definitive clinical findings [3] and a few nonspecific VNG abnormalities [4]. After exclusion of other conditions and by applying the diagnostic criteria, a diagnosis of Vestibular migraine was made. The patient is being treated conservatively.

Case summary: A 31-year-old woman complained of a few episodes of dizziness and persistent imbalance over the last 2 weeks. She had a long-standing history of episodes of headaches during which she reported intolerance to bright lights and loud sounds. The headaches as well as dizziness were related to periods of stress and mental exertion. She underwent pure tone audiometry, videonystagmography and MRI of the brain which were all within normal limits. A provisional diagnosis of vestibular migraine was arrived based on the history and by ruling out other causes of vertigo. Interventions: She was advised lifestyle modifications in terms of work life balance creation and measures to managestress [5].

Outcome: The patient is asymptomatic to date. She is receiving prophylactic medication for migraine. Regular visits to the therapist are helping in her overall approach to stressfull events in her life.

Conclusion: Vestibular migraine can be diagnosed by a process of exclusion of other conditions after detailed history, evaluation and investigations. Conservative treatment is often adequate.

Keywords: Vestibular migraine; VNG; Lifestyle alterations; diagnostic dilemma; Case report