Neurotological evaluation distinguishes vestibular migraine from viral neuritis in acute unilateral vestibulopathyA single case report shows rapid recovery in vestibular migraine

IntroductionVestibular migraine (VM) is one of the most frequent causes of recurrent episodic vertigo and is often misdiagnosed in emergency departments. Despite its high prevalence, its pathophysiology remains incompletely understood. In contrast, Acute Unilateral Vestibulopathy (AUVP) represents the prototypical peripheral acute vestibular syndrome, classically associated with vestibular neuritis, peripheral vestibular deafferentation, and gradual symptom recovery.Case descriptionA 40-year-old woman with a history of migraine with aura presented with recurrent episodes of severe vertigo over 2 months, associated with nausea, vomiting, and intense photophobia, often triggered by stress, sleep deprivation, and sweets. Interictal neurotological examination was normal, and VM was initially suspected. The following day, she presented to the emergency department with acute vertigo. Bedside examination, video-oculography, and video head impulse test demonstrated spontaneous left-beating nystagmus and reduced right horizontal canal gain, mimicking AUVP. The symptoms resolved on the same day while the patient was still under observation and repeated tests demonstrated restoration of vestibular function.ConclusionThis case highlights the hypothesis that migraine manifests as transient unilateral vestibular hypofunction, closely mimicking AUVP. Rapid recovery and atypical vestibulo-ocular reflex patterns may help distinguish migrainous deficits from viral vestibular neuritis, emphasizing the importance of neurotological evaluation during acute attacks.