Migraine and Vertigo

The incidence of vertigo in association with migraine has been reported to range between 50% and 70%, if one includes under the heading of vertigo sensations of dizziness, light-headedness and unsteadiness (Selby and Lance 1960; Kayan 1984). This surprisingly high incidence rate does not, however, reflect the clinical importance of vertigo in relation to other more characteristic and distressing symptoms of the disorder, since only one-third to one-half of these patients describe “true vertigo” which, after Kayan and Hood (1984), appears to be either the major symptom or a severe complication of migraine in only 5% of cases. In order to diagnose and treat this minority of migraine sufferers effectively, it is most important to know that vertigo attacks (with nystagmus and postural imbalance) may occur without accompanying headache (Table 15.1) in children (benign paroxysmal vertigo of childhood), adolescents (basilar artery migraine), and adults (benign recurrent vertigo). It is most important to obtain a thorough personal and family history to explore any association of vertigo attacks with headache or other typical features of migraine.