Vestibular Migraine: Treatment and Prognosis

Michael von Brevern, MD; Thomas Lempert, MD


Semin Neurol. 2020;40(1):83-86. 

In This Article

Counseling and Reassurance

First of all, patients need to be assured that VM is a bothersome but harmless condition that comes and goes, just like bad weather. Patients tend to see a neurologist when attacks are particularly frequent and severe. Thus, spontaneous fluctuations of disease activity will improve most of them over time. This "regression to the mean" effect and several therapeutic options justify conveying a cautiously optimistic prognosis.

A useful concept explains migraine as a permanent hypersensitivity of the senses and the nervous system, which peaks during attacks but may persist in the interval. This is why some patients may experience less intense symptoms even in between attacks, such as head-motion and visually induced dizziness, fatigability, and stress intolerance. Individual migraine triggers such as excessive stress, lack of sleep, food, and fluid may then lead to acute attacks. You may encourage your patients to reflect on these vulnerabilities and triggers to develop a sense of effective self-care, which includes regular sleeping and eating habits, taking breaks during work, and exercising regularly (for details on nonpharmacological migraine prophylaxis, see the next section). Comorbid psychiatric disorders, particularly anxiety and depression, occur in more than half of VM patients and may require referral to a psychiatrist or psychotherapist.[1]