Vestibular migraine is diagnosed clinically, from recurrent episodes of vertigo or dizziness lasting minutes to days in someone with a history of migraine, with migraine features accompanying at least half the episodes. No test confirms it. It is considerably more common than Meniere's disease yet diagnosed far less often, largely because people do not connect dizziness with migraine.
Vestibular migraine is diagnosed clinically, from recurrent episodes of vertigo or dizziness lasting minutes to days in someone with a history of migraine, with migraine features accompanying at least half the episodes. No test confirms it. It is considerably more common than Meniere's disease yet diagnosed far less often, largely because people do not connect dizziness with migraine.
The diagnosis requires recurrent vestibular episodes of moderate or severe intensity lasting between five minutes and seventy-two hours, a current or previous history of migraine, and migraine features during at least half the episodes. Those features include headache with typical migraine characteristics, sensitivity to light or sound, or visual aura. Notably the headache does not have to occur with every episode, and some people have vertigo attacks with no headache at all, which is why the migraine history matters so much.
It is considerably more common than Meniere's disease yet diagnosed far less often, partly because people do not connect dizziness with migraine and so do not mention their headache history, and partly because there is no confirmatory test to point to. Someone presenting with episodic vertigo who is not asked about migraine will often be worked up for inner-ear disease alone. Asking about photophobia and motion sensitivity during episodes frequently unlocks it.
Meniere's disease is the main differential and overlaps considerably; documented fluctuating hearing loss in one ear points there instead, which is why formal audiometry is useful. BPPV produces much briefer positional episodes. Vestibular neuritis is a single prolonged episode rather than a recurrent pattern. Central causes need considering, particularly where there are additional neurological features. VNG balance testing is performed at both CNS offices and is often normal or non-specific here.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: dizziness and vertigo; MedlinePlus: migraine; American Academy of Neurology.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.