Vestibular Migraine and Its Emotional and Sleep Comorbidities: Shared Mechanisms and Integrated Care
Vestibular migraine (VM) is a common cause of recurrent vertigo. Many patients with VM also report anxiety, depression, insomnia, and obstructive sleep apnea, and these problems are more frequent than in the general population or in patients with migraine alone. Standard care still focuses on vertigo and headache, and the emotional and sleep dimensions of VM are often under-recognized. Anxiety, depression, and sleep disturbance appear to influence one another and VM in both directions, increasing attack frequency, reducing quality of life, and complicating differential diagnosis. This review summarizes epidemiological evidence on these comorbidities, discusses shared pathophysiological mechanisms, including altered central vestibular and limbic network activity, serotonergic and GABAergic/glutamatergic dysregulation, and neurogenic inflammation—and outlines a practical diagnostic approach based on structured symptom assessment and standardized instruments. We then propose an integrated management framework that combines pharmacological prophylaxis and acute treatment, vestibular rehabilitation, neuromodulation, cognitive behavioral therapy, mindfulness-based interventions, and lifestyle modification. Recognizing and treating these comorbidities as part of VM, rather than as separate problems, may improve symptom control and quality of life.
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