Distinguishing Episodic Ataxia from Vestibular Migraine in Two Patients with History of Headache

Cases of episodic ataxia in patients with a history of migraine/headache are likely under-recognized, as the initial presentation may favor vestibular migraine. We present two cases of patients who were seen for symptoms of cerebellar dysfunction with suspected vestibular migraine. Both patients experienced persistent nystagmus and symptomatic improvement with acetazolamide, which prompted further genetic testing for EA. Through these cases, we highlight the clinical features of EA that ultimately allowed for differentiation from vestibular migraine. This ultimately reinforces the importance of considering the diagnosis of EA in all patients who present with cerebellar dysfunction.