Clinical and audiovestibular findings in pediatric vestibular migraine spectrum disorders.

OBJECTIVE: Vestibular migraine of childhood (VMC) and related episodic vertigo disorders are leading causes of recurrent pediatric dizziness, yet audiovestibular profiles remain incompletely defined. This study evaluates demographic and audiovestibular findings in children with VMC, probable VMC (pVMC), or recurrent vertigo of childhood (RVC). METHODS: Retrospective cohort study of pediatric patients diagnosed between January 2024 and December 2025. Data included demographics, migraine family history, and results of audiometry, videonystagmography (VNG), and video head impulse test (VHIT). Ethics approval was obtained. RESULTS: Thirty-two patients were included: 43.8% VMC, 53.1% pVMC, and 3% RVC. Mean age was 12.8 ± 3.5 years (range 5-17), with 59.3% female. Diagnostic delay averaged 9.5 months; 31% had prior neurology evaluation, 53.1% underwent brain imaging, and 21.2% electroencephalography. Audiometry (n = 17) showed unilateral mild-moderate hearing loss in three patients. VNG (n = 24) was abnormal in 70.8%, most commonly central positional nystagmus (50%). VHIT (71.8%) was abnormal in 43.7%. Migraine family history was present in 81.3% (first-degree 68.8%). CONCLUSION: Pediatric vestibular migraine spectrum disorders frequently demonstrate objective vestibular abnormalities with relatively infrequent hearing loss. Predominance of central positional nystagmus and frequent VHIT abnormalities suggest largely central vestibular involvement consistent with migraine pathophysiology. High rates of prior investigations and prolonged diagnostic delay highlight challenges in recognition. Earlier recognition and targeted audiovestibular evaluation may improve diagnostic efficiency and reduce unnecessary testing.