A 28-year-old woman with a long history of migraine presents with recurrent episodes of spinning vertigo lasting several hours, accompanied by photophobia. Between episodes, neurological examination, pure-tone audiometry, and caloric testing are all normal. The most likely diagnosis is:

• A Vestibular migraine ✓
• B Meniere's disease
• C Recurrent vestibulopathy secondary to microvascular compression
• D Vestibular paroxysmia

Explanation

Vestibular migraine is the commonest cause of episodic vertigo in patients with migraine, defined by at least five episodes of moderate to severe vestibular symptoms lasting 5 minutes to 72 hours with current or past migraine and migrainous features in at least half the attacks. The completely normal interictal audiovestibular workup excludes Meniere's disease, which shows fluctuating low-frequency SNHL, killing option B. Vestibular paroxysmia lasts seconds and responds to carbamazepine, killing option D.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.