Finding Relief for Vestibular Migraine
Vestibular migraine is a condition defined as having vertigo or dizziness when you also have migraine symptoms. Unlike typical migraine, a headache may not always accompany these symptoms; but vestibular migraine is no less debilitating.
Symptoms of vestibular migraine may include sensitivity to motion, feeling unsteady or dizzy, feeling disoriented, problems balancing, anxiety, and nausea or vomiting. In the words of one young woman who has a severe case, “I wasn’t able to walk in a straight line, and I had very much trouble concentrating, whether it be a person in front of me or an idea.”
How to Treat and Prevent Vestibular Migraine
Doctors aren’t sure what causes vestibular migraine. “Treatment options for vestibular migraine are extremely limited, so current treatment is focused primarily on reducing the frequency of migraine attacks,” writes Dr. William Renthal, PhD, in the Harvard Health Blog. Some preventive measures include:
Changes to diet: The best-known advocate for a nutritional approach to preventing vestibular migraine is Alicia Wolf, author of “The Dizzy Cook” cookbook. Diagnosed in 2016 after having no history of migraine or vertigo, Wolf found relief in following the migraine diet developed by Dr. David Buchholz, MD, at the Johns Hopkins University School of Medicine.
The list of prohibited foods (most containing tyramine or histamine) is long, Wolf acknowledges. The key is using the list as a starting point and then testing potential trigger foods for 4-5 days in a row. “This can be tricky because one day your threshold for a migraine could be much lower due to stress, weather, hormones, etc. and you could instantly get a migraine, whereas on good days where your threshold is higher, you could eat the trigger food and get by with it, not even realizing it’s a trigger,” she explains. Thanks to the diet, and limited medication use, Wolf says feels like “90-95%” of herself again.
Medications: Frequently prescribed medications for vestibular migraine include:
- Calcium channel blockers
- Tricyclic antidepressants
- Serotonin or serotonin/norepinephrine reuptake inhibitors (SSRIs or SNRIs)
Supplements: Many people with vestibular migraine find some relief in over-the-counter supplements, such as riboflavin (B2) and magnesium.
Vestibular rehabilitation: This is a specialized type of physical therapy for people who experience dizziness or vertigo. It might include posture and balance training, vision stability training, stretching and exercise.
What about acute treatment for vestibular migraine? Doctors may prescribe the triptans often used for migraine attacks, even if headache symptoms aren’t experienced. Antihistamines and other vestibular suppressants may be prescribed as well.
For a drug-free vestibular migraine treatment option, CEFALY DUAL has shown promise. A recent study published in the Journal of the Neurological Sciences showed that 19 out of 19 patients “reported improvement in vertigo severity” after using the CEFALY device to treat acute vestibular migraine attacks. This suggests that external trigeminal nerve stimulation (eTNS), the technology that drives CEFALY, may be an effective rescue therapy. “This study provides preliminary evidence that eTNS is a novel, non-invasive, safe and effective treatment for acute VM attacks,” Dr. Shin C. Beh reported.
This study is small, of course, and every person with vestibular migraine needs to try different treatment regimens to discover what works best for them. The Vestibular Disorders Association is a great resource for more information, with an active community that can offer support.