Distinguishing Meniere's disease from vestibular migraine: A comprehensive review of symptoms and diagnostic insights

Meniere's disease and vestibular migraine are common episodic vestibular syndromes whose overlapping vertigo, auditory, and migraine-associated features can complicate differential diagnosis. In this narrative review, we compared the diagnostic criteria, symptom patterns, pathophysiology, and complementary test findings of these syndromes. Vestibular migraine is diagnosed clinically based on recurrent vestibular symptoms, migraine history, temporal association with migraine features, and exclusion of alternative causes; audiological and vestibular evaluations are not required. In contrast, diagnosis of definite Meniere’s disease is made if the patient exhibits episodic vertigo with audiometrically documented low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms. Therefore, serial audiometry plays a direct role in the diagnosis of Meniere’s disease, whereas caloric testing, video head impulse testing, vestibular-evoked myogenic potentials, and hydrops imaging provide supportive rather than standalone discriminatory evidence. Emerging studies have identified distinct cytokine and immune signatures between Meniere's disease and vestibular migraine. In one research cohort, an interleukin-1 beta, CC motif chemokine ligand 3, CC motif chemokine ligand 22, and CXC motif chemokine ligand 1 cytokine panel has demonstrated high discriminatory performance (area under the curve = 0.995), whereas multiomic studies have identified divergent immune-cell pathways. However, external validation and standardized clinical thresholds are required before these approaches can be adopted for routine diagnosis. In practice, differentiation should be anchored in longitudinal history and consensus criteria, supplemented by serial hearing assessment and targeted vestibular or imaging studies when clinically indicated.