Vestibular Migraine: Treatment and Prognosis

Michael von Brevern, MD; Thomas Lempert, MD


Semin Neurol. 2020;40(1):83-86. 

In This Article

Does Your Patient Need Pharmacological Treatment?

Patients' expectations regarding drug treatment and doctors' actual prescriptions may be incongruous.[2] Many patients either do not expect or do not require medication. Some of them rather need to be relieved from their fear of a tumor or an imminent stroke. Others may have short or rare attacks, which argues against acute or prophylactic treatment, and still others do not like to take medication at all. On the other hand, both patients and doctors tend to overestimate the efficacy of treatments and underestimate their harms.[3,4] As a consequence, shared decision-making on the treatment of VM is based on discussing the expectations, therapeutic options, and limitations of the various approaches. Interestingly, only 36% of patients with VM who knew about their diagnosis and were informed about treatment options had tried migraine prophylaxis when they were reevaluated after a mean of 9 years. Only 13% were still on prophylactic medication.[5]