Treatments for vestibular migraine

How to treat a vestibular migraine?

Only a few clinical studies have been conducted on the specific treatment of vestibular migraine : during the attack or as prophylaxis, i.e. as background treatment for migraine .

Triptans for treating vestibular migraine

Two of these studies investigated the use of triptans for the treatment of attacks . Unfortunately, the validity of the first study is limited due to the small number of patients (n = 10), who reported only 17 attacks. The second study has a more robust methodology but did not conclude on the pain of the migraine attack. This study only shows that the triptan (rizatriptan) reduces motion sickness. Since none of the studies available to date are sufficient, most treatment recommendations for the prophylactic treatment of vestibular migraine are now based on the treatment guidelines for migraine with and without aura .

Migraine treatments effective in vestibular migraine

A large evaluation of 100 patients compared patients with vestibular migraine with and without migraine prophylactic treatment . All patients on treatment showed a decrease in the duration, intensity, and frequency of vertigo and its associated features.

The medications taken were: metoprolol or propranolol, valproic acid, topiramate, butterbur extract , lamotrigine, amitriptyline, flunarizine or magnesium .

Smaller cohorts have reported the effects of single drugs for migraine prophylaxis. Sodium valproate did not relieve vestibular symptoms in a group of 12 patients with vestibular migraine, but had a significant effect on migraine headache in eight of them. Cinnarizine was tested in an open-label study in vestibular migraine and migraine associated with vertigo. The study included 24 patients with vestibular migraine (23 women, 1 man) and 16 patients with basilar migraine (12 women, 4 men). Mean frequency of vertigo and mean frequency, duration, and intensity of migraines per month were significantly reduced after 3 months of treatment with cinnarizine.

No specific treatment

There is no specific treatment for vestibular migraines. Sometimes, it is necessary to act on the symptoms of vestibular migraine . The use of meclozine or other abortive drugs that suppress the vestibular system should be kept to a minimum and used only occasionally , as needed, for example during an episode. For frequent attacks , the doctor may recommend one or more of these drugs, as well as others:

• Beta-blockers
• Calcium channel blockers
• Tricyclic antidepressants
• Serotonin or serotonin/norepinephrine reuptake inhibitors (SSRIs or SNRIs)
• Topiramate

Treating a vestibular migraine naturally

People with vestibular migraines can reduce the number and intensity of episodes by maintaining a regular sleep and meal schedule, avoiding triggers , exercising regularly , and managing stress .

Feverfew and white willow are often beneficial. The HERBA Mig food supplement or the MIG SPRAY medical device have shown efficacy after 3 months of treatment.

Therefore, knowing what triggers headaches can help prevent migraine-related dizziness. Things like chocolate, cheese, alcohol, red wine , etc. can be triggers. If you suffer from vestibular migraines, these foods can also trigger your symptoms. You can try removing them from your diet to see if your symptoms improve a bit. Tracking your diet is another good way to find out if your dizziness symptoms are really due to headaches. For example, a high-salt diet can make dizziness symptoms worse if you suffer from Meniere's disease . Keep a food diary and show it to your doctor. It can help improve your diagnosis and treatment.