A clinician asked for input regarding a 56-year-old white male with recent onset of episodes of vertigo that lead to a disabling headache after a few minutes. Symptoms were accompanied by a flushed feeling and light and sound sensitivity. The patient had no history of trauma or infection. Nonsteroidal anti-inflammatory drugs (NSAIDs) had not proven helpful in resolving the pain. 


Magnetic resonance imaging (MRI) showed diffuse white-matter changes consistent with ischemia but no mass effect or other abnormality. Neuro-ophthalmologic workup was negative for visual etiology. Reproduction of the vertigo in the office by controlled rapid position changes confirmed the diagnosis of vestibular migraine. Recommended treatment depends on frequency and severity of occurrences, similar to uncomplicated migraine. (193-2)


Sherril Sego, FNP-C, DNP, is a primary-care nurse practitioner at the Department of Veterans Affairs Medical Center in Kansas City, Mo.


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