[Diagnosis and treatment of vestibular migraine - recent developments and future treatment strategies].

Vestibular migraine is a common cause of episodic vertigo and dizziness and affects up to 3% of all people. Characteristic symptoms include frequent episodes of vertigo (at least 5 attacks required) of varying duration (5 minutes to 72 hours) and at least moderate intensity, accompanied by other symptoms typical of migraine. To diagnose vestibular migraine, a (pre-existing) diagnosis of migraine with or without aura is required, as well as the simultaneous occurrence of migraine headaches, visual aura, or photo/phonophobia in at least every second vertigo attack. The spectrum of clinical presentations is broad, ranging from spontaneous, persistent vertigo/dizziness to isolated positional vertigo and accompanying hearing loss. Accordingly, the differential diagnosis and the associated investigations vary greatly depending on the clinical picture. Benign paroxysmal positional vertigo, Menière's disease, and acute stroke (at initial manifestation) are important entities that must be distinguished. Diagnostic workup usually reveals no structural abnormalities (magnetic resonance imaging and quantitative vestibular testing are normal), and there is no definitive test. Acute treatment of vestibular migraine is based on that of migraine with/without aura, but triptans should not be used in isolated episodes of vertigo/dizziness. Beta blockers, antidepressants, and antiepileptic drugs are proven approaches for preventive treatment, while the value of CGRP-antagonists and botulinum toxin A is still being researched, but initial results are promising.