Vestibular Migraine: A Systematic Literature Search and Narrative Review of Diagnostic Criteria, Pathophysiology, Differential Diagnosis, and Treatment Approaches.

This review aimed to summarize current evidence on the diagnostic criteria, pathophysiological mechanisms, differential diagnosis, and treatment approaches of vestibular migraine. A systematic literature search was conducted in PubMed/MEDLINE, Web of Science, and the Cochrane Library for studies published between May 2021 and May 2026. The search focused on vestibular migraine, migrainous vertigo, migraine-associated vertigo, diagnostic criteria, pathophysiology, treatment, prophylaxis, rehabilitation, and calcitonin gene-related peptide (CGRP)-related therapies. Study selection followed a PRISMA-informed process, and findings were synthesized narratively because of heterogeneity in study design, populations, interventions, and outcome measures. A total of 663 records were identified, and 72 studies were included in the final synthesis. Current evidence supports vestibular migraine as a complex disorder involving trigeminovascular activation, CGRP signaling, central sensitization, vestibulo-thalamo-cortical networks, and cerebellar compensation. Diagnosis remains primarily clinical and requires careful assessment of attack duration, vestibular symptom type, migraine-associated features, and exclusion of alternative vestibular or vascular disorders. Treatment evidence remains limited and heterogeneous. Lifestyle modification, conventional migraine prophylaxis, vestibular rehabilitation, and CGRP-targeted therapies may be useful in selected patients, but robust vestibular migraine-specific randomized trials are still insufficient. Vestibular migraine should be approached as a multisystem neurovestibular disorder rather than a simple coexistence of migraine and vertigo. Individualized, phenotype-based management and stronger controlled studies are needed to improve diagnostic accuracy and therapeutic decision-making.