Neurotological evaluation distinguishes vestibular migraine from viral neuritis in acute unilateral vestibulopathy

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Frontiers in Medicine Published June 4, 2026 Medically reviewed June 4, 2026 DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Rapid recovery and atypical reflex patterns may distinguish migrainous deficits from viral neuritis.

This case report details the experience of a 40-year-old woman with a history of migraine with aura who presented to the emergency department with vestibular migraine and acute unilateral vestibulopathy. The setting involved a neurotological evaluation conducted during the acute attacks. The primary outcome measured was vestibular function recovery, with secondary outcomes including vestibulo-ocular reflex patterns. The follow-up period was limited to the same day.

The main results indicated restoration of vestibular function. The authors compared this presentation against viral vestibular neuritis. Rapid recovery and atypical vestibulo-ocular reflex patterns may help distinguish migrainous deficits from viral vestibular neuritis. This distinction emphasizes the importance of neurotological evaluation during acute attacks.

The study is a single case report with a sample size of one. No medications were reported. No adverse events, serious adverse events, discontinuations, or tolerability data were reported. The authors did not report funding or conflicts of interest. No limitations were explicitly listed in the provided text. The practice relevance suggests that these clinical signs are useful for differentiation in the emergency setting.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

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.