Vestibular migraine is a neurological condition combining migraine headache symptoms with episodes of dizziness or vertigo. It can significantly disrupt daily life, causing sensations of spinning, unsteadiness, or rocking, often with headache, light, or sound sensitivity. Various medications can manage symptoms and reduce attack frequency, offering relief and improving quality of life.
Medications for Acute Relief
When a vestibular migraine attack occurs, medications can alleviate immediate symptoms.
Triptans
Triptans, such as sumatriptan or zolmitriptan, are commonly prescribed to abort headache and associated vestibular symptoms. These medications constrict blood vessels and block pain pathways in the brain, often providing relief within one to two hours. Side effects can include tingling, flushing, or chest tightness.
Antiemetics and Benzodiazepines
Antiemetics, like ondansetron or promethazine, manage severe nausea and vomiting during attacks. These drugs block brain receptors that trigger the vomiting reflex. Drowsiness and dry mouth are common side effects. For intense vertigo and anxiety, benzodiazepines such as lorazepam or diazepam may be used for short-term relief. These medications act on the central nervous system to reduce dizziness and calm the patient, though they can cause significant drowsiness and have potential for dependence.
Medications for Prevention
Preventive medications are taken regularly to decrease the frequency, severity, and duration of vestibular migraine episodes.
Beta-blockers
Beta-blockers, including propranolol and metoprolol, are frequently used. They slow heart rate and relax blood vessels, stabilizing neuronal activity and reducing migraine susceptibility. Side effects may include fatigue, dizziness, or a slowed heart rate.
Calcium Channel Blockers
Calcium channel blockers like verapamil or flunarizine help prevent blood vessels from narrowing and regulate brain activity, reducing migraine likelihood. Constipation, dizziness, and ankle swelling are possible side effects.
Tricyclic Antidepressants
Tricyclic antidepressants, such as amitriptyline or nortriptyline, are also employed for prevention, even in individuals without depression. They modulate neurotransmitters like serotonin and norepinephrine in the brain, influencing pain perception and migraine pathways. Dry mouth, drowsiness, and weight gain are common adverse effects.
Anti-seizure Medications
Anti-seizure medications, including topiramate and valproic acid, are effective in preventing migraines. They calm overactive nerve cells in the brain, which can contribute to migraine development. Side effects can include fatigue, dizziness, or changes in appetite.
CGRP Inhibitors
Newer, targeted therapies known as CGRP inhibitors, such as erenumab, fremanezumab, galcanezumab, and eptinezumab, specifically block calcitonin gene-related peptide (CGRP), a protein involved in migraine pain transmission. These injectable medications are well-tolerated, with injection site reactions being common side effects.
Developing a Personalized Treatment Plan
There is no single “best” medication for vestibular migraine; effective management involves an individualized approach. Healthcare providers consider several factors when determining the most suitable regimen. The frequency and severity of attacks play a significant role, as more frequent or debilitating episodes may warrant aggressive preventive strategies. Specific symptoms, such as whether vertigo or headache is more prominent, also influence medication choice.
Co-existing medical conditions, such as hypertension, anxiety, or depression, are evaluated because some medications can treat both vestibular migraine and these other conditions. Potential drug interactions are also a consideration. Patient preferences and tolerance for side effects are important, as adherence is crucial for effectiveness. The response to previous treatments guides future choices, with providers often trying different medications or dosages to find what works best. Working closely with a healthcare professional, such as a neurologist or otolaryngologist, is important to find the most effective and well-tolerated treatment plan, which often involves a trial-and-error process requiring patience and ongoing communication with the medical team.