A 30-year-old woman has had five discrete attacks of spinning vertigo over six months, each lasting several hours, accompanied by throbbing headache, photophobia, and phonophobia. Audiometry, caloric testing, and MRI brain are all normal. She has a lifelong history of migraine with aura. The most likely diagnosis is:

• A Definite Meniere's disease
• B Definite vestibular migraine ✓
• C Vestibular paroxysmia
• D Recurrent vestibular neuritis

Explanation

Definite vestibular migraine requires at least five episodes of vestibular symptoms of moderate severity lasting 5 minutes to 72 hours, a current or past history of migraine, migrainous features such as headache, photophobia, or phonophobia in at least half the attacks, and exclusion of other causes. Normal hearing and normal vestibular testing exclude Meniere's disease, whose attacks last 20 minutes to 12 hours but always involve fluctuating sensorineural hearing loss. Vestibular paroxysmal attacks last seconds.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.