Recurrent Vertigo of Childhood Revisited: Clinical Findings Supporting a Developmental Vestibular Migraine Spectrum

Background: Complaints of vertigo and dizziness are frequently encountered in childhood and may coexist with migraine-associated features. The present study reassessed a historical pediatric cohort within an expanded phenotypic framework. Methods: This retrospective multicenter descriptive study analyzed 146 children aged 3–12 years evaluated for recurrent vestibular symptoms between 1995 and 2022 at two Italian tertiary neuro-otological referral centers. Clinical history and neuro-otological examination represented the common diagnostic foundation, while age-appropriate audiological evaluation was performed in virtually all children and additional vestibular or imaging investigations were clinically selective. Results: Of the 146 children, 144 fulfilled the 2021 Bárány Society criteria for Recurrent Vertigo of Childhood (RVC), whereas two presented with isolated benign paroxysmal torticollis. None fulfilled the criteria for Vestibular Migraine of Childhood or probable Vestibular Migraine of Childhood. Headache was reported in 15.8% of patients, whereas motion sensitivity, sensory hypersensitivity, autonomic symptoms, and additional migraine-associated developmental syndromes were frequently observed. Conclusions: In this selected tertiary cohort, the clustering of migraine-associated features was compatible with a developmental migraine-related vestibular spectrum. These phenotypic associations do not demonstrate longitudinal disease evolution, and prospective longitudinal studies are required.