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Getting rid of vestibular migraines involves managing the active episode (acute treatment) and preventing further episodes (prophylactic treatment).
Treatment of vestibular migraines involves managing the active episode (acute treatment) and preventing further episodes (prophylactic treatment).
- Acute treatment: It focuses on providing relief from an ongoing attack of vestibular migraine.
- Treatment consists of the following:
- Vestibular suppressants: These medications include drugs such as benzodiazepines (such as diazepam and lorazepam), antihistamines (such as dimenhydrinate and meclizine), and antiemetics (medications that control vomiting, such as promethazine and prochlorperazine). These medications help manage migraine symptoms that last more than 20 to 30 minutes accompanied by significant nausea or vertigo. They can be given orally or rectally.
- Triptans: These medications include sumatriptan, zolmitriptan, and rizatriptan. They work like the brain chemical serotonin and help reduce migraine symptoms such as pain, vertigo, sensitivity to light or sound, nausea, and vomiting.
- Nonsteroidal anti-inflammatory drugs: These medications, such as ibuprofen or naproxen, do not specifically target a migraine headache. They may be given along with the other two specific migraine treatments.
- General measures: Rest and avoiding movements, bright lights, and loud sounds may help too.
- Treatment consists of the following:
- Prophylactic treatment: Focuses on preventing future vestibular migraine attacks.
- Prophylactic treatment may consist of:
- Medications:
- Beta-blockers such as propranolol
- Tricyclic antidepressants such as amitriptyline and nortriptyline
- Serotonin-norepinephrine reuptake inhibitors such as venlafaxine and desvenlafaxine
- Topiramate (an antiepilepsy medication)
- Calcium channel blockers such as flunarizine
- Nutritional supplements such as magnesium and riboflavin
- Avoiding triggers: This may be done by managing stress, ensuring proper sleep, avoiding bright lights, eating meals on time, ensuring proper hydration, and avoiding foods that trigger a vestibular migraine. Although exercise may trigger a vestibular migraine, adequate physical activity and weight management may help manage a migraine better. Thus, one must stay active and ensure that they maintain hydration and perform adequate warm-up and cool-down activities with each workout.
- Treatment of underlying conditions: Some underlying health conditions may act as vestibular migraine triggers. Treatment of these conditions may help prevent future vestibular migraine attacks. These conditions may include motion sickness, anxiety, and benign paroxysmal positional vertigo.
- Medications:
- Prophylactic treatment may consist of:
What are the symptoms of a vestibular migraine?
Vestibular migraine is a type of migraine characterized by vertigo, dizziness, balance problems, ringing in the ears (tinnitus), motion intolerance, and sensitivity to light (photophobia) and sound (phonophobia). These symptoms may or may not be associated with a headache or visual aura (such as seeing flashes of light).
Symptoms may last from a few minutes to three days (72 hours) during which the person may experience the following:
- Vertigo (a sensation that they are spinning or falling or their surroundings are spinning or moving)
- Loss of balance or unsteadiness
- Light-headedness
- Nausea and vomiting that may be worsened by head movements
- Headache (typically one-sided)
- Tinnitus
- Fullness in the ears
- Intolerance to loud sounds or bright lights
- Hearing impairment
These symptoms may subside and then recur with some people experiencing them several times a day.
What are the common triggers of a vestibular migraine?
Some of the common triggers of vestibular migraines include:
- Sleep deprivation
- Bright lights
- Seeing moving objects such as patterns or moving trains
- Rapid head motion
- Emotional stress
- Skipping meals
- Weather changes
- Hormonal changes in women
- Strong odors
- Certain foods (such as baked goods, yogurt, kefir, vinegar, tomatoes, onions, olives, nuts and nut butter, aged cheese, caffeine, foods containing monosodium glutamate, and soy products)
- Exertion or exercise
- Alcohol
- Smoking
- Straining at stools
- Sexual intercourse
Does a vestibular migraine ever go away?
A vestibular migraine cannot be cured. With adequate treatment and lifestyle measures, however, one can control the severity and frequency of symptoms.
Several studies report that proper management (through medications and lifestyle modifications) significantly lowers the frequency and severity of vestibular migraine attacks.
