Abstract
Background: Indoor mold exposure (IME) has been associated with nonspecific neurological symptoms, including dizziness, cognitive complaints, and fatigue. Whether environmental exposures related to damp indoor environments influence vestibular migraine (VM), a common cause of episodic vertigo involving interactions among vestibular and migraine-related pathways, remains unclear. Objective: To examine the overlap between vestibular symptoms reported in association with IME and those characteristic of VM, and to explore how this overlap may contribute to potential diagnostic misattribution when environmental factors are not adequately considered during clinical assessment. Methods: A hypothesis-driven narrative review was conducted using PubMed and Scopus, synthesizing evidence on VM, symptoms reported in association with IME, and potential biological mechanisms to explore potential explanations for overlapping vestibular symptoms and their implications for diagnostic misattribution. An illustrative clinical case was included to provide clinical context for the proposed hypothesis. Results: Findings identify overlapping vestibular symptoms between patients with VM and symptoms associated with IME. However, the available evidence is largely indirect, and no studies have directly investigated whether this symptom overlap contributes to diagnostic misattribution of VM. Conclusions: Evidence remains insufficient to establish diagnostic misattribution of VM in the context of indoor mold exposure. Environmental exposure history should be considered alongside established diagnostic criteria, and further research is needed to investigate this possibility.