Allergy and Distinct Clinical Features in Episodic vs. Vestibular Migraine: Diagnostic Implications

Background: Migraine, including vestibular migraine (VM), is a complex neurological disorder with diverse symptoms. VM is primarily characterized by vertigo attacks, while episodic migraine (EM) is more associated with headache features. This study aims to identify the distinguishing characteristics and comorbidities of VM and EM. Methods: A retrospective analysis was conducted using databases from Mersin University and Brain 360 Integrative Brain Health Center, encompassing 333 patients (248 EM, 85 VM) diagnosed according to the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria between 2021 and 2023 to examine various migraine features and comorbidities. Results: Both EM and VM were predominantly observed in women with similar age distributions. EM patients exhibited significantly longer symptom duration and higher frequencies of nausea, photophobia, and phonophobia (p<0.05). No significant differences were found in vomiting, osmophobia and allodynia rates (p=0.147, p=0.109, p=0.822), while motion sickness was more prevalent in EM (p<0.05). EM patients also showed greater prevalence of migraine family history, menstrual associations, metabolic syndromes, and fibromyalgia (p<0.05). Although headache severity was similar, EM attacks lasted longer. Sleep disorders and medication overuses were more common among EM patients (p<0.05). EM patients reported more sleep disorders, medication overuse, and emotional stress, while dizziness was more common in VM patients (p<0.05). Conclusions: Migraine-like features and comorbidities are generally more prevalent and diverse in EM patients, revealing a distinct pattern compared to VM patients. These findings suggest a broader spectrum of VM symptoms beyond current diagnostic criteria, highlighting the need for more comprehensive longitudinal studies.