This interesting discussion paper begins with an overview of the background to the development of vestibular migraine as a separate diagnostic category. It discusses in some depth the diagnostic uncertainties in the context of an entity without a biomarker and where an understanding of pathophysiology is incomplete. This paper provides a useful summary of ‘the story so far’ for vestibular migraine, including a table outlining the consensus criteria used in diagnosis. However, it goes further to reach to the decidedly fuzzy edges of the diagnosis, tackling the potentially knotty problem of comorbidity, highlighting the list of vestibular conditions that occur more frequently in those with migraine including BPPV, Menieres and motion sensitivity. This paper provides a helpful overview of vestibular migraine as currently understood but also rightly highlights the uncertainties inherent in the diagnosis. The calls for further research, validation and definition of this condition are timely given the danger that this is becoming the diagnosis of least resistance when more easily identified causes have been excluded. 

Comorbidities in vestibular migraine.
Eggers SDZ, NEH BA Neff, NT Shepard NT, Staab JPO.
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Fiona Barker

Department of Clinical Medicine and Ageing, University of Surrey, UK.

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