Introduction: An estimated one-fourth to one-third of patients with migraine will experience vertigo associated with their migraine attacks. Vestibular migraine frequently presents as a diagnostic challenge as objective neurological findings consistent with this entity have not been well described. Objective: The aim of this study is to characterize eye movements of patients presenting with nystagmus during attacks of migrainous vertigo. Design: A retrospective study of 26 patients presenting with nystagmus during an acute vestibular migraine was performed. All patients were examined while symptomatic during a migraine spell, and also while asymptomatic. All patients underwent tests of vestibular function with either bithermal water caloric or rotary chair electronystagmography. Results: The most common patient was a female of perimenopausal age. Spontaneous nystagmus was seen in 19% of patients and nystagmus provoked by horizontal headshaking was seen in 35%. Nystagmus could be provoked with positional testing in 100% of symptomatic patients with fixation blocked. The positional nystagmus most commonly was sustained, of low velocity, and could be horizontal, vertical or torsional. Bithermal water caloric or rotary chair tests obtained during symptom-free intervals were normal in all patients. Conclusions: Although nystagmus characteristics are quite variable during vestibular migraine, the finding on examination of low-velocity, sustained nystagmus with positional testing in a young to middle-aged adult patient presenting with vertigo, nausea and headache is highly suggestive of vestibular migraine as long as the nystagmus dissipates when the patient is free of symptoms.

Ashkenazi A, Silberstein SD: Hormone-related headache: pathophysiology and treatment. CNS Drugs 2006;20:125–141.
Bahra A, Matharu MS, Buchel C, Frackowiak RSJ, Goadsby PJ: Brainstem activation specific to migraine headache. Lancet 2001;357:1016–1017.
Baloh RW: Neuro-otology of migraine. Headache 1997;37:615–621.
Cao Y, Aurora SK, Nagesh V, Patel SC, Welch KMA: Functional MRI-BOLD of brainstem structures during visually triggered migraine. Neurology 2002;59:72–78.
Cohen HS: Side-lying as an alternative to the Dix-Hallpike test of the posterior canal. Otol Neurotol 2004;25:130–134.
Cutrer FM, Baloh RW: Migraine-associated dizziness. Headache 1992;32:300–304.
Dieterich M, Brandt T: Episodic vertigo related to migraine (90 cases): vestibular migraine? J Neurol 1999;246:883–892.
Evans RW, Baloh RW: Episodic vertigo and migraine. Headache 2001;41:604–605.
Geisler C, Bergenius J, Brantberg K: Nystagmus findings in healthy subjects examined with infrared videonystagmoscopy. ORL 2000;62:266–269.
International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain. Cephalalgia 2004;24(suppl 1):24–37.
Kayan A, Hood JD: Neuro-otological manifestations of migraine. Brain 1984;107:1123–1142.
Kuritzsky A, Toglia UJ, Thomas D: Vestibular function in migraine. Headache 1981;21:110–112.
Marano E, Marcelli V, Di Stasio E, Bonuso S, Vacca G, Manganelli F, Marciano E, Perretti A: Trigeminal stimulation elicits a peripheral vestibular imbalance in migraine patients. Headache 2005;45:325–331.
Mraovitch S, Calando Y, Goadsby PJ, Seylaz J: Subcortical cerebral blood flow and metabolic changes elicited by cortical spreading depression in rat. Cephalalgia 1992;12:137–141; discussion 127.
Neuhauser H, Lempert T: Vertigo and dizziness related to migraine: a diagnostic challenge. Cephalalgia 2004;24:83–91.
Savundra PA, Carroll JD, Davies RA, Luxon LM: Migraine-associated vertigo. Cephalalgia 1997;17:505–510.
Selby G, Lance JW: Observations on 500 cases of migraine and allied vascular headache. J Neurol Neurosurg Psychiatry 1960;23:23–32.
Sunami K, Tochino R, Zushi T, et al: Positional and positioning nystagmus in healthy subjects under videonystagmoscopy. Acta Otolaryngol Suppl 2004;554:35–37.
Vass Z, Steyger PS, Hordichok AJ, Trune DR, Jancsó G, Nuttall AL: Capsaicin stimulation of the cochlea and electric stimulation of the trigeminal ganglion mediate vascular permeability in cochlear and vertebro-basilar arteries: a potential cause of inner ear dysfunction in headache. Neuroscience 2001;103:189–201.
von Brevern M, Radtke A, Clarke AH, Lempert T: Migrainous vertigo presenting as episodic positional vertigo. Neurology 2004;62:469–472.
von Brevern M, Zeise D, Neuhauser H, Clarke AH, Lempert T: Acute migrainous vertigo: clinical and oculographic findings. Brain 2005;128:365–374.
Weiller C, May A, Limmroth V, et al: Brain stem activation in spontaneous human migraine attacks. Nat Med 1995;1:658–660.
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