Migrainous vertigo is one of the commonest cause of episodic vertigo and is increasingly recognized among neurootologists and migraine specialists. The clinical presentation is heterogeneous with spontaneous and positional vertigo lasting seconds to days and inconsistent temporal relationship to headache and other migrainous features. Findings during the acute episode suggest that several pathophysiological mechanisms can be involved. There are no evidence-based guidelines for therapy available. Presently, migrainous vertigo is not included in the classification of the International Headache Society (IHS). We propose that the diagnosis of definite migrainous vertigo can be made in a patient with migraine according to the IHS with at least two attacks of vestibular vertigo accompanied by migrainous symptoms when other causes are excluded.