Making the diagnosis
Diagnostic criteria
Vestibular migraine is a clinical diagnosis with formal, internationally agreed criteria. Learn the four-part logic, then try it on the interactive checker.
A consensus framework
There is no blood test or scan for vestibular migraine. Instead, doctors use an agreed checklist: enough attacks of the right kind and length, a link to migraine, and making sure nothing else explains it better.
The Bárány Society and the International Headache Society published joint criteria in 2012, updated in 2022.1,2 They define two tiers — definite and probable VM — and lean on the ICHD-3 definition of migraine for criterion B.3
The criteria deliberately require a migraine link rather than headache-with-every-attack, and they retain a probable category for the many patients who meet only one of the two migraine criteria. Treat the framework as a structured aid to a clinical judgement that still rests on excluding mimics over time.
Definite vestibular migraine
All four must be met:
- A. ≥ 5 episodes of vestibular symptoms of moderate or severe intensity, lasting 5 minutes to 72 hours.
- B. Current or previous history of migraine with or without aura (ICHD-3).
- C. One or more migrainous features with ≥ 50% of the vestibular episodes — a migrainous headache, photophobia and phonophobia, or visual aura.
- D. Not better accounted for by another vestibular or ICHD diagnosis.
Probable VM is met when criterion A and D hold but only one of B or C is satisfied.1
Try it — the criteria checker
Toggle each criterion to see how the consensus logic resolves to definite VM, probable VM, or criteria-not-met. Note how dropping criterion D (mimics excluded) always defeats the diagnosis, and how B and C trade off between definite and probable.
Bárány Society criteria — checker
Investigations — to exclude, not to confirm
No test confirms VM. Investigations serve criterion D: audiometry to exclude the progressive low-frequency loss of Ménière’s, and MRI where the history, examination or risk profile raises a central or vascular concern. A normal interictal examination is expected and reassuring.
Key points
- Definite VM = criteria A ∧ B ∧ C ∧ D; probable VM = A ∧ D ∧ exactly one of B, C.
- Criterion A anchors on ≥ 5 episodes lasting 5 min – 72 h, moderate or severe.
- Criterion C is met by a migrainous headache, photophobia + phonophobia, or visual aura.
- Investigations exclude mimics (criterion D) rather than confirm VM.