What abortive and preventative treatments have you found to be helpful for a vestibular migraine?

Topics: Neurology • Headache • Neuro-Otology

If a patient progresses from discrete episodes (hours long) of mild vertigo with rare headaches, but associated migrainous features (photophobia and nausea) to chronic daily dizziness with occasional episodes of worsening and photophobia, does this still represent vestibular migraine or another condition such as persistent postural perceptual dizziness (PPPD)?

Answer from: at Academic Institution

I still treat using the same medication guidelines as for any migraine presentation. I am more likely to try venlafaxine in these patients. For off-label/guidelines, I am also more likely to try gabapentin and acetazolamide. In addition to pharmacologist management, I have a low threshold to refer f...

Comments

at First Choice Neurology
A helpful clue to distinguish PPPD from vestibular...

Answer from: at Community Practice

If vestibular migraine is indeed an entity, of which I am by far convinced, the pharmacotherapy aligns with general migraine management. This includes triptans and gepants for abortive treatment and gepants along with CGRP antibodies for preventive measures. The objectives are to achieve complete he...

Comments

at Harvard Medical School
I agree. I was taught by a headache specialist or ...

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