Do we need to reconsider the classification of vestibular migraine?

ABSTRACT

Introduction: Vestibular migraine (VM) is a complex disease characterized by recurrent episodes of migraine associated with vertigo attacks that are observed in 1–3% of the general population. Given its high prevalence and the impact on the health system, it is important to characterize these patients, in order to offer an accurate diagnosis and a proper treatment. As the diagnosis of VM is based on clinical features, the study of potential biomarkers has gained more interest in the last years, to improve the precision in the diagnosis of this disease. The aim of this review is to summarize the main tests available for the diagnosis of VM, including the accuracy of biomarkers for the diagnosis of VM.

Areas covered: This review summarizes the main information on VM, including all diagnosis records published in the field in the last 10 years, and focusing on candidate biomarkers for the diagnosis of VM patients.

Expert opinion: There is a limited knowledge in the pathophysiology of VM. The search of biomarkers for diagnosis of VM is needed to improve the precision in the diagnosis promoting clinical and translational research. The potential reclassification of VM will depend upon the discovery and validation of these biomarkers.

KEYWORDS:

• Clinical classification
• biomarkers
• diagnosis
• patient characterization
• vestibular migraine

Article highlights

• VM is now classified into ‘vestibular migraine’ and ‘probable VM.’ VM definition should be used for clinical research.

• Several biomarkers including cytokines have been described for VM in small series, and validation studies in large cohorts are much needed.

• Biomarkers will allow a reclassification of VM. For this, a better clinical characterization of patients with VM should guide the diagnosis of these patients.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Additional information

Funding

This work was partially supported by the Instituto de Salud Carlos III and European Regional Funds under Grant [numbers FI18/00228 and PI20/1126]; Andalusian Health Government under Grant [PE-0356–2018].