Vestibular Migraine: A Primer

Shin C. Beh, MD

Disclosures

November 08, 2019

Editorial Collaboration

Medscape &

Background

A 45-year-old man complains of experiencing dizziness, on and off, for about 2 years. He describes episodes of feeling as though he were falling through space and spinning, aggravated by bright lights, loud sounds, and head movements. These disturbances are associated with nausea, vomiting, trouble walking, ringing in both ears, and fatigue. Most of the episodes are accompanied by a perception that his body is shrinking to a point that he feels as small as an insect in comparison with his surroundings. These episodes last for hours, affect his daily activities, and occur about once every 2-3 months.

He has a history of hypertension, episodic migraine without aura, depression, and anxiety. The hypertension is controlled with lisinopril, and citalopram adequately controls his mood. He denies any history of psychotic disorder, and there was no initiation of any new medication prior to the onset of these episodes.

Physical Examination

The patient's neurologic examination was normal. Neuro-otologic and neuro-ophthalmic examinations were unremarkable. Videonystagmography (VNG), caloric reflux testing, interictal EEG, and brain MRI revealed no significant abnormalities. Laboratory testing, including complete blood count (CBC), comprehensive metabolic panel (CMP), vitamin B12 level, rapid plasma reagin, HIV antibodies, thyroid function tests, and urine toxicology screen, were within normal limits. Audiometry testing documented normal hearing function.

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