Vestibular Migraine: Treatment and Prognosis

Michael von Brevern, MD; Thomas Lempert, MD


Semin Neurol. 2020;40(1):83-86. 

In This Article

Nonpharmacological Prophylaxis

Many patients with VM are unwilling to take daily medication and instead prefer nonpharmacological interventions. One out of two U.S. adults with migraine use complementary and alternative therapies.[33] Behavioral interventions including relaxation training, biofeedback training, and stress management training (i.e., cognitive behavioral therapy) have shown similar and clinically meaningful improvement compared with medications in the prevention of migraine headache.[34] Furthermore, a combination of pharmacological and behavioral migraine prophylaxis is more effective than either intervention employed singularly.[35] Dissemination of these therapies in everyday clinical practice is poor, but advances in internet-based delivery platforms may provide better access to self-management strategies.[34] Although behavioral interventions have not been evaluated in VM, it is likely that they are also effective in this migraine variant, which is often afflicted by psychiatric comorbidity, most commonly anxiety and somatoform disorders.[36]

There is limited evidence for the effectiveness of aerobic exercise,[37] acupuncture,[38] and nutraceuticals[39] such as magnesium, riboflavin, and coenzyme Q10 for the prevention of migraine headache. Regular exercise seems to reduce symptoms in VM,[40] but other interventions have not been evaluated in patients with VM.