Vestibular migraine may be an important cause of dizziness/vertigo in perimenopausal period.

Migraine disorders are more prevalent among women than men. The ovarian neurosteroids play an important role in this sex difference by modulating neurotransmitter systems involving migraine pathogenesis. During perimenopause, unlike the postmenopausal period, women are under unstable fluctuations of ovarian neurosteroid levels. Such fluctuations might be an important interval-specific trigger for activating migraines. Along with migraine headache, dizziness is one of the most common complaints of perimenopause. A significant portion of this dizziness may be caused by vestibular migraine that has heterogeneous clinical features with dizziness and/or migraine headache. Because of this variation in phenomenology, the symptom of dizziness and vertigo during perimenopause is frequently misclassified as being a nonspecific climacteric symptom or having psychological origin. The recognition of vestibular migraine and its heterogeneous clinical presentations are important to understand, differentiate and correctly diagnose the symptom of dizziness and vertigo during perimenopausal transition. Further, recognition of the steroid influences on migraine genesis will lead to improved treatment regimens for vertigo from migraine.