Abstract:
Introduction. Differential diagnosis (DD) between Vestibular migraine (VM) and Meniere’s disease
(MD) is challenging because both conditions present with recurrent episodes of vertigo. Correct
differentiation is essential due to differences in pathophysiology, prognosis, and treatment strategies.
Materials and Methods. A systematic literature review (2020–2026) was performed using PubMed,
Scopus, and Web of Science, including original studies, reviews, and clinical guidelines on diagnostic
criteria, pathophysiology, and treatment of VM and MD.
Results. MD is a peripheral vestibular disorder associated with endolymphatic hydrops, characterized
by excessive accumulation of endolymph in the membranous labyrinth. Clinically, MD presents with
recurrent rotational vertigo accompanied by progressive sensorineural hearing loss, tinnitus, and aural
fullness. Episodes usually last from 20 minutes to several hours and are often associated with nausea
and vomiting. Hearing loss fluctuates at the early stage, mainly affecting low frequencies, and
gradually progresses. The disease often begins unilaterally and may later involve the opposite ear. VM
is the most common cause of recurrent spontaneous vertigo of central origin. Attacks last from minutes
to hours and are often associated with migraine features such as headache, photophobia, phonophobia,
or visual aura, although headache may be absent. Persistent hearing loss is uncommon, and audiometry
is usually normal. Vestibular symptoms may be positional and triggered by stress, sleep deprivation,
or dietary factors. Progressive cochlear symptoms favor MD, whereas migraine features without
auditory deficit suggest VM. Acute MD attacks are treated with vestibular suppressants and
antiemetics, while long-term therapy includes salt restriction, betahistine, and diuretics; refractory
cases may require surgery. VM treatment follows migraine therapy principles: NSAIDs, triptans,
benzodiazepines, or dihydroergotamine are used during attacks, while prophylaxis includes betablockers, antidepressants, calcium channel blockers, acetazolamide, and antiepileptic drugs.
Conclusions. DD should be based on clinical characteristics of vertigo, presence of progressive
hearing loss, and audiometric findings. Repeated audiometry and modern diagnostic criteria improve
accuracy and allow appropriate treatment selection.
