Vertigo with a headache — vestibular migraine

Vestibular migraine is the diagnosis the inter-ictal examination keeps announcing: episodes lasting hours with headache and photophobia, a completely normal examination between them, and a quiet audiogram — the Bárány and International Headache Society criteria written as a person. Neuhauser’s epidemiology put it at the top of the recurrent-vertigo list, and the Brain review carries the treatment framing a therapist needs: migraine management leads — neurology, triggers, regularity — and vestibular rehabilitation is reserved for the patients left unsteady between attacks, never delivered inside one. What you do with it: retire the “recurrent neuritis” label with the criteria in hand, send her to neurology with the trigger diary started, keep the maneuver kit closed, and offer rehabilitation only if the quiet window turns out to be less quiet than today’s examination.

• New hearing loss, tinnitus or aural fullness joining the episodes — the Ménière’s question reopens, and the audiogram is repeated
• A change in the headache character or any persistent focal sign between episodes — neurology before the next rehabilitation session

• The spinning bed — posterior canal BPPV, right earTier 1
• The grocery-store dizziness — PPPDTier 2

This page carries the case’s first decision. The full sequence — every decision, the examination by domain, and the debrief that grades you — is in the drill, and the library is included with membership.