What is migraine-associated vertigo?

Updated: Jun 17, 2021
  • Author: Aaron G Benson, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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The manifestations of migraine-associated vertigo are quite varied and may include episodic true vertigo, positional vertigo, constant imbalance, movement-associated dysequilibrium, and/or lightheadedness. [1, 2, 3]

Symptoms can occur before the onset of headache, during a headache, or, as is most common, during a headache-free interval. Consequently, many patients who experience migraines have vertigo or dizziness as the main symptom rather than headache. For this reason, this article is devoted to the description of migraine-associated vertigo.

Since the 19th century, repeated references have been made to the clinical association of migraine and dizziness. Over the years, several syndromes of episodic vertigo associated with migraine have been reported, including benign paroxysmal vertigo of childhood and benign recurrent vertigo in adults. [4, 5] Some authors have even suggested an association between migraine and Ménière disease.

Vertigo is also a symptom of basilar migraine, a migraine variant that is also known as Bickerstaff syndrome [6] (and that was previously known as basilar artery migraine).

See Vertigo: 5 Case-Based Diagnostic Puzzles, a Critical Images slideshow, to help recognize diagnostic clues in vertigo cases.

Although the definition of migraine-related vertigo and the continuum of the symptom complex remains poorly defined, the relationship is clearly more than a chance association.

In a well-controlled study that evaluated 200 patients from a migraine clinic, a dizziness clinic, and a control group from an orthopedic clinic, the group presenting with vertigo showed a higher lifetime prevalence of migraine (38%) than did a similar group of patients in the control group (24%). [7] Similar findings have been seen in studies evaluating migraine patients. Vertigo, as well as chronic, nonspecific symptoms of vestibular system dysfunction, can be related to all forms of migraine.

A study by Wang et al indicated that persons with migraine-associated vertigo experience greater cognitive impairment than do persons who suffer from simple migraine. Subjects with migraine-associated vertigo scored lower on cognitive tests than did those with simple migraine, while magnetic resonance imaging (MRI) demonstrated a greater incidence of deep brain, peripheral lateral ventricle, and total white matter lesions in the migraine-associated vertigo group than in the other. [8]

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