Otoneurologist’s impression of vestibular migraine

Headache and dizziness are the two most common complaints in patients who see doctors of different specialties. Moreover, an undoubted association between these two symptoms (simultaneous vs sequential occurrence) is identified during the depth patient enquiry. Variability of clinical symptoms together with the widest diversity and ambiguity of vestibular reactions, as well as the lack of instrumental options for adequate diagnosis complicates diagnosis of vestibular migraine (VM). VM is currently diagnosed only on the basis of clinical criteria accepted by the international medical community. The differential diagnosis between VM and Meniere’s disease is no less urgent. Both diseases are only diagnosed using clinical symptoms (based on accepted clinical criteria) and have multiple overlaps in clinical presentation. In many cases, patients with VM are not only treated according to the Meniere’s disease patient management protocol for many years, but also undergo surgical interventions eventually bringing absolutely no relief. However, even a true diagnosis of VM does not guarantee a fast and high-quality choice of preventive treatment due to a large range of groups of drugs used (beta-blockers, calcium channel blockers, anti-CGRP monoclonal antibodies, serotonin and norepinephrine reuptake inhibitors amongst the so-called pain-relieving antidepressants, antiepileptic drugs, some antipsychotic drugs), and their efficacy does not exceed 75%. But the combination of two diseases with interweaving of similar enough and difficult to diagnose VM and Meniere’s disease aggravating the course of each other in one patient represents the most difficult situation.