Vestibular Migraine. Predominantly women are affected by VM (i.e., 1.5– 5.6:1 female preponderance) in their late 30s to mid-40s (Xxxxxxxxx et al., 2006; Xxx et al., 2019). VM is currently the most common cause of spontaneous vertigo other than BPPV (Xxxxxxxx et al., 2016) and often underdiagnosed (Beh et al., 2019; Xxxxxxx and Xxxxxxxx, 2020). People with VM may describe a wide variety of peripheral and central vestibular symptoms. The most common vestibular symptoms that occur during VM attacks include spontaneous and/or positional vertigo, especially after a change in head position, dizziness or vertigo triggered or aggravated by head movements, postural unsteadiness, oscillopsia (xxx Xxxxxxx et al., 2005; Xxxxxxxxx et al., 2006; Teggi et al., 2018; Xxx et al., 2019), ViD (Xxxxxx et al., 2006; Xxxxxxxx et al., 2009), and directional pulsion (Teggi et al., 2018; Xxx et al., 2019). Most people with VM may complain of more than one vestibular symptom during VM episodes (Beh et al., 2019). The duration of vestibular symptoms varies widely between and within people but could be between five minutes and 72 hours (Xxxxxxxx et al., 2016; Xxxxxxx et al., 2022). Instead of a painful headache, some people with VM may only perceive a sensation of head pressure or fullness, lightheadedness, blurriness, or light dizziness but these symptoms are just as severe as a head pain is to others (Xxxxxxx and Xxxxxxxx, 2020; Xxxxxxx et al., 2022). Because headaches may not be associated with vestibular symptoms, to make the diagnosis of VM, it is important to inquire about other migranous features, including photophobia, phonophobia, and aura (Xxxxxxxxx et al., 2001; Xxxxxxxxx et al., 2006; Xxx et al., 2019; Xxxxxxx et al., 2022). Aura is a complex, reversible neurological manifestation that occurs during or before the onset of the headache phase in migraine (IHS-3, 2018). Visual aura is the most common form of aura occurring either alone or in combination with other auras in 98% of cases (Xxxxxxx et al., 2004). It is characterised by bright scintillating lights or zigzag lines, often accompanied by a scotoma that interferes with reading (Xxxxxxx et al., 2022). Typically, visual auras last between five and 20 minutes and for less than 60 minutes. They are often, but not always restricted to one hemifield. Other types of migraine aura, e.g., somatosensory, or dysphasic aura, are not included as diagnostic criteria because their phenomenology is less specific, and most people also have visual auras....
