PREVALENCE OF BENIGN PAROXYSMAL POSITIONAL VERTIGO AMONG ADULTS PRESENTING WITH ACUTE MIGRAINE IN A TERTIARY CARE SETTING

Abstract

Background: Dizziness and vertigo are also common symptoms during migraine or other peripheral vestibular disorders such as benign paroxysmal positional vertigo (BPPV) can exist but not be clinically recognized. Objectives: The aim of the study was to assess the prevalence of benign paroxysmal positional vertigo (BPPV) among adults with acute migraine and to describe the demographic characteristics of BPPV patients (age and gender). Another goal was clinical evaluation of BPPV such as involvement of the semicircular canals, laterality and duration of vertigo symptoms. Methods: This was a prospective cross-sectional study that was carried out at the Department of Neurology, Pak Emirates Military Hospital, Rawalpindi, from April 2026 to July 2026. Consecutive enrollment of adults (18-65 years) who presented within 72 hours of migraine onset and met the International Classification of Headache Disorders, 3rd edition (ICHD-3) inclusion criteria. Both standardized Dix–Hallpike and supine roll testing (if indicated) were performed by trained neurologists in all patients. BPPV was diagnosed by the presence of typical positional vertigo and nystagmus. Results: Among 216 participants, 142 (65.7%) were female and the mean age was 38.4 ± 11.2 years. BPPV was identified in 34 patients, giving a frequency of 15.7% (95% CI: 11.2–21.3%). The involvement of the posterior canal was predominant (76.5%) followed by the horizontal canal involvement (17.6%). The most frequent was right-sided involvement (58.8%). There was no difference in age between BPPV-positive patients and BPPV-negative patients (42.1 years vs. 37.6 years; p=0.03). There was no statistically significant difference in sex distribution (P=0.08), with BPPV positive being female and BPPV negative being male. Conclusion: The prevalence of BPPV in adults presenting with acute migraine was about one in six. Regular positional testing can help identify this treatable comorbidity early and decrease diagnostic delay and unnecessary testing.