While the presence or history of migraine is essential for its diagnosis, the headache and dizzy symptoms do not need to temporally coincide. The diagnosis is primarily based on clinical history, and international guidelines have been developed. VM is now considered as the first cause of episodic vertigo in adults, and it is a common diagnosis in children. Vestibular migraine (VM) is characterized by recurrent vestibular attacks that are not associated with migraine headache. (4) Conclusion: we propose the consideration of the presence of pupillary nystagmus as an objective sign (present in the inter-critical phase) to be associated with the international diagnostic criteria for the diagnosis of vestibular migraine. This resulted in a test sensitivity of 0.93% and a specificity of 0.94%. Among the 50 non-migraineurs dizzy patients, three had pupillary nystagmus, while the remaining 47 did not. (3) Results: Among the 30 VM patients, only two cases were found to be negative for pupillary nystagmus. (2) Methods: 30 patients with dizziness suffering from vestibular migraine (VM), diagnosed according to the international criteria, were evaluated for the presence of pupillary nystagmus and compared with the results obtained in a group of 50 patients complaining of dizziness that was not migraine-related. The aim of this study is to verify the presence of pupillary nystagmus in a series of patients suffering from vestibular migraine. (1) Background: Hippus (which in this paper will be called “Pupillary nystagmus”) is a well-known phenomenon which has never been related to any specific pathology, so much so that it can be considered physiological even in the normal subject, and is characterized by cycles of dilation and narrowing of the pupil under constant lighting conditions.
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