The interplay between dizziness, vertigo, and headache has been a subject of longstanding clinical debate. This review aims to provide a comprehensive overview of the current understanding regarding the classification, pathogenesis, and management of this complex clinical presentation. It focuses on the International Classification of Headache Disorders, Third Edition (ICHD-III), which provides a comprehensive framework for the classification of headache disorders. Particular attention is paid to “migraine with brainstem aura,” “vestibular migraine,” and “hemiplegic migraine,” as these subtypes are often challenging to differentiate clinically due to their overlapping symptomatology with dizziness and vertigo. The underlying pathophysiological mechanisms linking dizziness, vertigo, and headache are multifaceted and not yet fully elucidated. Emerging evidence suggests that shared neuroanatomical and neurochemical pathways may contribute to the co-occurrence of these symptoms. Detailed exploration of the underlying pathogenetic pathways is crucial for developing targeted therapeutic interventions. Various clinical assessment tools, including the Headache Diary, are discussed as valuable resources for accurate diagnosis and targeted treatment of headache disorders associated with dizziness and vertigo. These assessment measures can facilitate effective physician-patient communication and optimize clinical decision-making. The complex relationship between dizziness, vertigo, and headache requires a thorough understanding of the underlying pathophysiology and a systematic approach to clinical evaluation and management. Adoption of validated assessment tools can contribute to improved patient outcomes and strengthen the clinician’s ability to provide evidence-based care.

[Purpose] There have been no reports of vestibular rehabilitation (VR) for the symptom of dizziness developing after temporal bone fracture. We report the case of a patient who presented with disequilibrium after temporal bone fracture, in whom we performed a detailed assessment of the vestibular function and VR. [Methods] The patient was a male in his 30s with left temporal bone fracture, who complained of still experiencing episodic vertigo while walking. VR and vestibular function assessment were conducted once a week for five weeks starting from the 22nd day after injury. The evaluated parameters included the subjective visual vertical (SVV), average vestibulo-ocular reflex gain in the lateral plane in the video Head Impulse Test (vHIT), average latency of catch-up saccades (CUS), score on the visual analogue scale (VAS) for dizziness sensation in the Head Shaking Nystagmus Test, the mean left-right position of the center of pressure during the Romberg test with the eyes closed for 60 seconds, the 95% confidence ellipse area, and the mean velocity of sway. [Results] Comparison of the results of testing conducted on days 22 and 57 revealed an increase of the left gain on the vHIT from 0.37 to 0.55 and decrease of the CUS. The SVV shifted from left bias to neutral. Although right horizontal nystagmus persisted in the Head Shaking Nystagmus Test, the score on the VAS decreased. In the Romberg test, the mean position shifted from left bias to right bias, and the 95% confidence ellipse area and mean velocity decreased. [Discussion] Despite the remaining decrease in gain in the vHIT, improved compensatory function through VR and habituation likely led to the subjective improvement of dizziness in the patient.

We adopted intratympanic dexamethasone injection therapy for 17 patients with Meniere’s disease who were resistant to conservative treatment for more than six months and continued to suffer from recurrent vertigo attacks. A 1-ml dose of dexamethasone injection solution (4.0 mg/ml) was administered intratympanically on a weekly basis at an outpatient clinic. The average monthly frequency of vertigo attacks during the six months prior to dexamethasone administration was compared with the average monthly frequency of vertigo attacks from 18 to 24 months after the treatment. Reduction in the frequency of vertigo attacks was observed in 15 out of the 17 cases. There was no significant change in hearing after the treatment as compared with before. Inner ear MRI with contrast was performed in 10 cases, and while cases with larger endolymphatic hydrops tended to have a poorer control of vertigo, no significant difference was observed. There were no cases of tympanic membrane perforation. Intratympanic dexamethasone injection therapy may be a potentially effective treatment for cases of refractory Meniere’s disease resistant to conservative therapy.

Benign paroxysmal positional vertigo (BPPV) due to peripheral vestibular lesions is the most common type of vertigo encountered in clinical practice. The purpose of this study was to compare the otolith organ function of patients with BPPV with that in healthy volunteers, and evaluate otolith organ dysfunction.

Video-oculography goggles were used to measure ocular counter-rolling (OCR) in 15 patients with BPPV and 21 healthy volunteers. For all subjects, the otolith-ocular function of both ears was tested separately by the measurement of OCR under a 30° head tilt. The R-L side asymmetry ratio for OCR values (%OCRA) was compared with the patients’ OCR values under static conditions. We also performed subjective visual vertical (SVV) testing in both groups of subjects.

The %OCRA differed significantly between patients with BPPV and the healthy volunteers (p < 0.01). However, there was no significant difference in the SVV value between the two groups. In most of patients with BPPV, when the head was tilted toward the healthy ear side, the OCR value tended to become lower.

It has been reported that in patients with utricular organ dysfunction, a head tilt toward the healthy ear side leads to a decrease of the OCR value. In general, BPPV is considered as being caused by detachment of the otolith from the utricular macula. We consider measurement of OCR as a useful testing method to evaluate otolith organ, especially utricular organ function, in patients with BPPV.