Vestibular Migraine: Treatment and Prognosis

Michael von Brevern, MD; Thomas Lempert, MD


Semin Neurol. 2020;40(1):83-86. 

In This Article

Abstract and Introduction


Treatment of vestibular migraine currently lacks a firm scientific basis, as high quality randomized controlled trials are not available. Therefore, recommendations are largely borrowed from the migraine sphere. The first therapeutic step is explanation and reassurance. Many patients do not need pharmacological treatment, as attacks may be infrequent and tolerable. Acute attacks can be ameliorated in some patients with antiemetic drugs such as diphenhydramine, meclizine, and metoclopramide. Frequent attacks may warrant pharmacological prophylaxis with metoprolol, amitriptyline, topiramate, valproic acid, or flunarizine. Nonpharmacological measures including regular exercise, relaxation techniques, stress management, and biofeedback may be similarly effective and can be combined with a pharmacological approach. Limited data indicate that the prognosis appears to be less favorable for vestibular migraine than for migraine headaches.


Vestibular migraine (VM) is probably as old as mankind, but systematic research of the condition only started in the last three decades. Treatments of VM have not been evaluated by sufficiently large and well-designed controlled trials. Instead, numerous retrospective case series have been published that yielded positive outcomes for almost any taken approach. However, before-and-after comparisons are not suitable to measure treatment effects as they are contaminated by spontaneous improvement, placebo effect, and potentially biased evaluations by unblinded investigators. In the lack of firm evidence, current recommendations are largely borrowed from the therapeutic armory of migraine headache, which has a more solid scientific basis.