Can we tell the difference between benign recurrent vertigo, migraine and Menière’s disease?
Reviewed by Anand Kasbekar

I chose to review this article as it reminds us of the difficulties in diagnosing dizzy patients accurately and the significant crossover of symptoms between the diagnoses. Does Benign Recurrent Vertigo (BRV) even exist as a separate entity? BRV is essentially chronic recurrent spontaneous attacks of vertigo lasting from minutes to hours without cochlear or neurological symptoms. Diagnosis is difficult as patients (unfortunately) can have BRV as well as migraine; a small number can also develop unilateral hearing loss and therefore BRV can be considered to be a vestibular form of Menière’s disease (MD). The Dutch authors recruited 122 patients with a diagnosis of either BRV (37%), vestibular migraine (VM) (28%) or MD (35%). The patients underwent an audiogram, vestibular tests and completed symptom questionnaires to determine if there are certain symptoms unique to BRV. Unfortunately no specific clinical characteristics were found for BRV. Females were more likely to have VM or BRV. Motion sickness was far more common in VM patients and MD patients were more likely to have nausea and vomiting. Although the study sample size was small, more numbers I don’t think would have helped provide an answer. Lastly, caloric testing (testing only the lateral canal) was used rather than vHIT and VEMP testing which would have provided a more thorough vestibular assessment. I certainly have seen patients which seem to fit a diagnosis of BRV although time will tell if they end up with VM or MD.

Clinical characteristics of benign recurrent vestibulopathy: clearly distinctive from vestibular migraine and Menière’s disease?
van Esch BF, van Wensen E, van der Zaag-Loonen HJ, van Benthem PPG, van Leeuwen RB.
OTOLOGY AND NEUROTOLOGY
2017;38(9):357-63.