Vestibular migraine (VM) is among the most common causes of vertigo. Numerous studies have shown that the origin is within the central vestibular structures rather than the labyrinth itself, producing abnormal findings of both central and peripheral patterns including; vertical or torsional spontaneous nystagmus, gaze evoked nystagmus, and positional vertigo and nystagmus mimicking “non-classical” BPPV. Radtke et. al. ( Neurology 2012;79:1607-1614) have recently published a longitudinal study following 61 migraine patients (54 women and 7 men) aged 24-76 years for a median time of 9 years. The investigators found the majority of VM patients continue to have recurrent vertigo, and the impact of the vertigo remains high. They also report that at least 50% of their patients also had mild bilateral cochlear symptoms. A distinction between Meniere’s patients, is that their cochlear involvement manifests as a more severe unilateral SNHL. The investigators conclude that controlled trials with migraine prophylaxis are needed to improve long-term outcome in severely affected patients.