A 37-year-old woman presented to the otolaryngology department with a 6-week history of recurrent weekly episodes of dizziness, which she described as a sensation of swaying, along with occasional rotatory vertigo. These episodes were typically followed by right-sided headaches that lasted several hours and occurred once a week. Associated symptoms included transient visual aura (flashing lights), short-lasting blurred vision, and occasional nausea. She denied any hearing problems, tinnitus, or phonophobia. The headaches and dizziness tended to worsen with fatigue, bright lights, and high caffeine intake and were relieved after rest in a dark room. There was a notable catamenial exacerbation of her symptoms. She recalled having similar episodes a few years ago, which had resolved spontaneously without medical treatment.
Upon examination, her vital signs were normal, and clinical findings were unremarkable. There were no neurological deficits. Otoscopic and neurological examinations were normal, and no nystagmus was observed. Magnetic resonance imaging (MRI) of the brain and inner ear—including FIESTA axial views focused on the internal auditory meatus—was normal with no signs of vestibular schwannoma, cerebellopontine angle lesions, or vertebrobasilar stroke. Based on the clinical history, symptom triggers, and associated features, the patient was diagnosed with vestibular migraine, characterized by recurrent vertigo with migrainous features such as aura, unilateral headache, and nausea, with MRI ruling out structural or vascular causes.