Migraine-associated vertigo: diagnosis and treatment

Semin Neurol. 2010 Apr;30(2):167-74. doi: 10.1055/s-0030-1249225. Epub 2010 Mar 29.


Migraine-associated vertigo has become a well-recognized disease entity diagnosed based on a clinical history of recurrent vertigo attacks unexplained by other central or peripheral otologic abnormalities, which occurs in the patient with a history of migraine headaches. There is no international agreement on what spectrum of symptoms should be covered under this diagnosis, or what terminology should be used. The headaches and vestibular symptoms of migraine-associated vertigo may not be temporally associated, which often obscures the association. Diagnostic tests usually show nonspecific abnormalities that are also seen in patients with migraine who do not experience vestibular symptoms. Management generally follows the recommended treatment of migraine headaches, and includes dietary and lifestyle modifications and medical treatment with beta blockers, calcium channel blockers, and tricyclic amines. Small case series show that acetazolamide and lamotrigine appear to be more effective for the vertigo attacks than headaches. Vestibular rehabilitation has also been shown to be helpful in several studies. In this review, the epidemiologic and clinical features of the disorder, as well as the current state of knowledge on pathophysiology, diagnostic testing, and treatment are described.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Anticonvulsants / therapeutic use
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Brain / drug effects
  • Brain / physiopathology*
  • Calcium Channel Blockers / therapeutic use
  • Humans
  • Migraine Disorders / complications
  • Migraine Disorders / physiopathology*
  • Neuropharmacology / methods*
  • Vertigo / diagnosis*
  • Vertigo / drug therapy*
  • Vertigo / physiopathology
  • Vestibule, Labyrinth / drug effects
  • Vestibule, Labyrinth / physiopathology*


  • Adrenergic beta-Antagonists
  • Anticonvulsants
  • Antidepressive Agents, Tricyclic
  • Calcium Channel Blockers