Vestibular migraine as a mimic of benign paroxysmal positioning vertigo and Meniere’s disease

BACKGROUND: Vestibular migraine (VM) is a common cause of recurrent spontaneous and positional dizziness of varying durations. Short episodes of VM lasting seconds to minutes, triggered by changes in head position can resemble those of benign paroxysmal positioning vertigo (BPPV), while episodes lasting minutes to hours can mimic those of Meniere’s disease (MD). OBJECTIVE: We aimed to compare symptoms and vestibular test results in patients with VM, BPPV and MD, where VM was categorized by episode duration. METHODS: We compared vestibular, aural and migraine symptoms, as well as cervical and ocular vestibular evoked myogenic potentials and 3D video head impulse tests, in 108 patients: 24 with BPPV, 33 with VM episodes of short duration (<10 min), 29 with VM of medium duration (≥10 min) and 22 with MD. RESULTS: We found significant overlap in the symptoms of all patient groups, and no significant differences between patients with short and medium VM. Abnormal test results occurred infrequently in all groups. CONCLUSIONS: Our results confirm significant symptom overlap between BPPV or MD and VM, and suggest that VM mimics other conditions when the episode duration matches the differential diagnosis, rather than because patients with different durations of vertigo have different symptoms.