Vestibular Migraine (VM) is a neurological condition linking typical migraine symptoms with disturbances in the vestibular system, which controls balance and spatial orientation. This condition is a common cause of episodic vertigo, where individuals experience intense dizziness or a spinning sensation. These episodes often occur alongside headache, light sensitivity, or sound sensitivity. The vertigo can last from minutes to days, significantly disrupting a person’s ability to maintain balance. Effective management of VM involves a multi-pronged approach combining acute treatments, daily preventive medications, and therapeutic exercises.
Immediate Relief Strategies
When a vestibular migraine attack begins, the primary goal is to interrupt the process quickly to minimize the duration and severity of symptoms. These acute treatments are distinct from daily preventive medications and are used solely on an as-needed basis. Triptans, a class of migraine-specific medications, are often the first-line choice, especially when a severe headache accompanies the vertigo. These drugs work by targeting serotonin receptors to constrict blood vessels and block pain pathways in the brain.
For many patients, the most debilitating symptoms are the vertigo, dizziness, and intense nausea. Vestibular suppressants, such as certain anti-nausea or anti-vertigo medications, manage these symptoms directly. Over-the-counter options like meclizine can help with dizziness, while prescription antiemetics, such as metoclopramide or prochlorperazine, are effective against severe nausea. Newer CGRP receptor antagonists, known as gepants, are also emerging as acute treatment options for VM symptoms by blocking the action of the pain-signaling CGRP protein.
Immediate behavioral steps are also helpful to manage the intensity of an attack. Moving to a dark, quiet room and resting can reduce sensory input that often exacerbates both headache and vestibular symptoms. Acute medications should generally be limited to two days per week to prevent medication-overuse headache, which can increase attack frequency.
Long-Term Preventive Medications
For individuals experiencing frequent or severely disabling vestibular migraine attacks, daily preventive medications reduce the overall frequency and intensity of episodes. These pharmaceutical agents are typically drawn from several classes of drugs originally developed for other conditions, such as cardiovascular disease or epilepsy.
Beta-blockers, like propranolol or metoprolol, are widely used and are particularly helpful for patients who also have coexisting hypertension. These medications modulate brain excitability and are a common first-line choice for general migraine prevention that extends to VM.
Another frequently prescribed group includes anti-seizure medications, such as topiramate and valproate. Topiramate has proven effective in reducing both headache and vertigo frequency. Tricyclic antidepressants, such as amitriptyline, are often used at low doses and are beneficial for patients who experience coexisting sleep disturbances or anxiety alongside their VM. These drugs modulate neurotransmitter activity, which helps to stabilize the over-excitable migraine brain.
Calcium channel blockers, such as flunarizine, are also used for prevention. In recent years, Calcitonin Gene-Related Peptide (CGRP) monoclonal antibodies have become available for migraine prevention. These newer biological treatments, which include drugs like erenumab and fremanezumab, are administered via injection and specifically target the CGRP pathway. Selecting the right preventive regimen requires close collaboration with a neurologist, as the choice often depends on a patient’s other health conditions and potential side effects.
Vestibular Rehabilitation and Lifestyle Adjustments
Beyond medication, non-pharmaceutical approaches centered on therapeutic exercise and lifestyle changes form a substantial part of long-term VM management. Vestibular Rehabilitation Therapy (VRT) is a specialized form of physical therapy that helps the brain compensate for the disordered signals from the inner ear. A physical therapist utilizes VRT to improve balance, reduce dizziness, and decrease motion sensitivity through targeted exercises.
The therapy uses techniques like habituation exercises, which involve repeated exposure to movements that provoke mild dizziness to desensitize the vestibular system. Balance retraining exercises and gaze stabilization drills are also incorporated. VRT works by promoting neuroplasticity, retraining the central nervous system to better handle the sensory conflict that characterizes VM symptoms.
Crucial lifestyle adjustments can significantly reduce the frequency of attacks by minimizing exposure to known triggers. Maintaining excellent sleep hygiene is paramount, meaning adhering to a consistent sleep schedule and ensuring adequate rest. Identifying and avoiding dietary triggers is another important step.
Common triggers include:
- Aged cheeses
- Red wine
- Caffeine
- Foods containing monosodium glutamate (MSG)
Regular, moderate exercise and stress management techniques, such as mindfulness or relaxation training, are also recommended to help stabilize the neurological system.