Dizziness in children: Vestibular migraine was the most common diagnosis

For Healthcare Professionals:

Dizziness in children and adolescents is challenging to diagnose: Symptoms are described differently depending on age, several syndromes can resemble each other, and rare central or systemic causes must not be overlooked. A new prospective cohort study from a specialized dizziness center shows how broad the diagnostic spectrum is – and which diseases were particularly common.

🔗 Original study

Study design

The researchers prospectively analyzed 519 children and adolescents aged 1 to 18 who presented with dizziness or balance problems at a specialized dizziness and balance center between August 2010 and January 2024.

The diagnostics It included a structured anamnesis as well as standardized neurological, oculomotor, and neurootological examinations. Apparent tests – such as vHIT, Kalorik, VEMP, posturography, or audiometry – were supplemented depending on age and clinical indication. Using machine learning algorithms, the authors developed a diagnostic decision-making pathway based on the most important characteristics.

The most common diagnoses

Diagnosis group	Share
Vestibular migraine of childhood	41 %
Persistent postural-perceptual dizziness (PPPD)	18 %
Recurrent dizziness in childhood	10 %
Orthostatic dizziness	6 %
Episodic ataxia	3 %
Heterogeneous rarer diseases	23 %

Important: The percentages are rounded. The 23 % „rare diseases“ do not form a uniform diagnostic group; instead, they included, among other things, brain tumors, genetic or congenital diseases, and infections.

Age changes the diagnostic spectrum

In children under 11 years of age, a recurring childhood-onset form of dizziness was more frequently diagnosed. In contrast, adolescents experienced the vestibular migraine This highlights the importance of considering the child's age more frequently when determining the diagnosis. This suggests that the weight of possible diagnoses should be adjusted based on age, developmental stage, and the nature of the symptoms described.

Persistent postural-perceptual dizziness (PPPD) is relevant in children

PPPD In this cohort, which had 18 women as % the second most common diagnosis group, the second most common diagnosis was associated with high levels of daily stress. The authors describe characteristics that differ from those of adult patients. Therefore, the term should not be used too quickly to equate it with any form of nonspecific fatigue or automatically with the adult appearance of PPPD.

What does this mean for diagnostics?

• Dizziness in children is not a „small adult problem“: the causes and clinical presentation are age-dependent.
• A structured history should also include headache, duration of attacks, triggers, orthostatic complaints, family history, and limitations in school and leisure activities.
• Neurological, oculomotoric and neuroophthalmic findings help to distinguish common syndromes from each other and to identify red flags.
• Unintentional broad-based diagnostics – for example, an MRI without clinical indications – can possibly be avoided if the history and examination are clearly structured. In the case of neurological abnormalities or other warning signs, further medical evaluation is of course required.

Practical messageDo not prematurely classify dizziness in children as „circulatory“ or „psychiatric“. At the same time, the diagnosis distribution from a specialized outpatient clinic does not mean that every child needs extensive diagnostic testing. What is crucial is an age-appropriate, hypothesis-guided examination process.

How reliable are the results?

The prospective survey, the large pediatric sample, and standardized medical diagnosis are clear strengths. Nevertheless, all data come from a highly specialized university center. The percentages are therefore not prevalence estimates for the general population or for a general practitioner or physical therapy practice.

The data-based diagnostic algorithm was also developed from the same cohort. Without independent external validation, it is still unclear how reliable it works in other healthcare contexts. The study also describes diagnoses and diagnostic characteristics, not the effectiveness of a specific therapy.

Conclusion

In this specialized cohort, vestibular migraine was the most common cause of dizziness in children and adolescents. PPPD was also common, while almost a quarter fell under heterogeneous, rarer diagnoses. Structured, age-appropriate history taking and neurological-neurophysiological examination can differentiate frequent syndromes, specifically identify rare causes, and reduce unnecessary diagnostics.

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For Patients – Easy to Understand

Dizziness in children: Why an accurate examination is important

📄 Original study

Children often describe dizziness differently than adults. Some say it’s all in their head. Others report a „funny feeling,“ nausea, or an inability to walk, and suddenly they no longer want to walk. Therefore, it’s important not to just ask for the word „dizziness.“.

In a recent study, 519 children and adolescents were examined at a specialized dizziness center. The doctors most commonly found: vestibular migraine. Dizziness attacks can also occur when headaches are not the primary concern every time.

What did the study show?

• 41 % had one vestibular migraine.
• 18 % had one Persistent postural-perceptual dizziness (PPPD), which can significantly disrupt everyday life.
• 10 % had recurring childhood-onset vertigo.
• In 23, different rarer diseases were % found.

These figures do not apply to all children with dizziness. A special group was examined; they had already been referred to a specialized center.

When should dizziness be medically evaluated?

Recurrent, severe or new-onset dizziness should be discussed with a physician – especially if additional new neurological findings, severe headaches, hearing problems, fainting, fever, significant difficulty walking, or a rapid deterioration occur. In case of suddenly severe symptoms, urgent medical evaluation is required.

Conclusion

Dizziness in children has many possible causes. A timely medical history and examination help to identify common causes and to avoid overlooking rare diseases.

🎯 Our certified IVRT® dizziness and vestibular therapists can provide individual support: IVRT therapist search