Reference

Compare

Two clinical archetypes side-by-side across the seven-finding vocabulary used in the pattern trainer. Shared features (both prominent) describe what they have in common; discriminatingfeatures (prominent in one, uncommon in the other) are the ones that should drive the differential at the bedside.

Findings side-by-side

  1. Cervical triggerSymptoms reliably reproduced by specific neck positions or movements; head-on-trunk provocation increases dizziness.
    Prominent
    Variable
  2. Visual dependenceSymptoms substantially worse in busy visual environments — supermarkets, traffic, crowds, scrolling screens.
    Variable
    Variable
  3. Episodic discrete attacksDiscrete bouts of moderate-to-severe vestibular symptoms with well intervals in between; not continuous.
    Uncommon
    Prominent
  4. Migraine featuresPhotophobia, phonophobia, throbbing headache, aura, or other migrainous accompaniments around the episodes.
    Uncommon
    Prominent
  5. Positional spinningBrief (<60s) spinning vertigo on specific head positions — lying down, rolling in bed, looking up.
    Uncommon
    Uncommon
  6. Autonomic prominenceNausea, pallor, sweating, or palpitations dominate the experience over the sense of motion itself.
    Uncommon
    Variable
  7. Brainstem featuresDiplopia, dysarthria, perioral numbness, drop attacks, or sudden 'unwell' feeling on a stereotyped trigger.
    Uncommon
    Uncommon
Both prominent — shared feature One prominent, other uncommon — discriminating One prominent, other variable Neither prominent

Bedside discriminators

  • Episodic discrete attacks favours Vestibular migraine over Proprioceptive cervicogenic (Route 1).
  • Migraine features favours Vestibular migraine over Proprioceptive cervicogenic (Route 1).

Proprioceptive cervicogenic (Route 1)

Disturbed cervical proprioception is the dominant mechanism — usually after whiplash or chronic neck stiffness. Symptoms track the neck.

Read more — Module 08 — Route 1 →

Vestibular migraine

Discrete vestibular attacks with migrainous accompaniments. Premonitory neck stiffness is a recognised feature. The most commonly missed alternative to cervicogenic dizziness.

Read more — Module 07 — Vestibular migraine →