Vestibular Migraine Revisited: A Narrative Review of Diagnostic Challenges and Treatment Strategies

Vestibular migraine (VM) is a common yet frequently underdiagnosed neurological condition, marked by recurrent episodes of vertigo and othervestibular symptoms in association with migraine features. It predominantly affects women aged 30-50 years and has an estimated prevalenceof 1%-5% in the general population. This narrative review explores current knowledge surrounding VM, including its epidemiology, proposedmechanisms, diagnostic complexities, and treatment approaches. The pathophysiology remains incompletely understood but may involve dysfunction in vestibule-cerebellar pathways, ion channel abnormalities, and trigeminal system activation. Diagnosing VM is clinically driven, requiring careful evaluation of vestibular complaints alongside migraine-associated symptoms. Patients commonly report vertigo and headaches,while clinical assessment may uncover ocular motor disturbances, canal paresis, and balance issues. Supplementary tests such as ocular andcervical vestibular evoked myogenic potentials can aid in diagnosis, though they are not definitive. Differential diagnosis is essential due to symptom overlap with other vestibular disorders like Ménière’s disease, episodic ataxia type 2, and benign paroxysmal positional vertigo. Treatmentincludes acute interventions with vestibular suppressants and triptans, vestibular rehabilitation programs, and preventive pharmacotherapysuch as β-blockers, calcium channel blockers, and certain antidepressants. Despite these options, clinical evidence remains scarce, primarily relying on small-scale trials and expert consensus. No universally effective regimen has yet been identified. Overall, VM poses significant diagnosticand therapeutic challenges, underscoring the need for further research to clarify its mechanisms, improve diagnostic precision, and developevidence-based treatment strategies that could lessen its burden and improve patient outcomes.Cite this article as: Vlastarakos P, Sideris G, Kourklidou M, Bousi V, Michailidou E, Nikolopoulos T. Vestibular migraine revisited: A narrative reviewof diagnostic challenges and treatment strategies. J Int Adv Otol. 2025, 21(5), 2042, doi:10.5152/iao.2025.252042.