How Often Do Vestibular Migraines Occur – Vestibular migraine can produce daily dizziness, but can also occur in disabling attacks. Symptom changes can be moderated by using preventive medications, which work to prevent attacks before they occur. But as people who live with migraines know, sometimes attacks happen and we leave people to get rid of them as soon as they appear. This is where treatment for severe migraines comes in.
When used early in the symptoms or in the middle of a full attack, the treatment of acute vestibular migraine can help to completely stop the symptoms or reduce the severity of the attack.
How Often Do Vestibular Migraines Occur
In common migraine attacks that involve headache, these are usually pain relievers such as naproxen (Aleve), ibuprofen, acetaminophen, triptans (special pain meds for headaches), and ergotamines. But what do you take if you don’t get headaches with your migraine attacks? Don’t worry, you have options!
Migraine Associated Vertigo (mav), Vestibular Migraine
Very little is known about the effects of these migraine headaches. Those who live with VM know that not every attack involves a headache or migraine. In fact, up to 50% of people can have a headache without a headache. So what kind of symptoms are experienced during a bad vestibular headache attack?
If any of these sensations do not cause pain, but are only terrifying and debilitating in their form, how can we stop them? Here are some new and existing vestibular migraine treatments that can be used quickly.
Until recently, I really believed that the only effective medications for vestibular migraine that existed were benzodiazepines and antihistamines such as meclizine. It was previously thought that triptans had no effect on vertigo, and only worked on migraine headaches. However, some small studies show some success. Two randomized trials showed little evidence supporting the use of rizatriptan and zolmitriptan in vestibular headache attacks.
In one study, rizatriptan showed some promise in 15 subjects who experienced motion sickness due to vestibular issues. 13 of the 15 showed a reduction in motion sickness after taking rizatriptan, compared to placebo. However, with increased stimulation, patients did not experience sustained benefit. This appears to be one of the most common triptans for people with vestibular migraine.
Striking The Right Balance
In another small study, zolmitriptan showed a small benefit at a dose of 5mg, proving a benefit in 3 out of 8 attacks of vestibular headache. However, the placebo group showed a benefit in 2 out of 9 attacks.
Again, both of these studies are limited because of the number of participants, but with regard to Vestibular Migraine in general, there are really only a few small studies in general. This type of treatment is something Dr. Beh wants to write more, as mentioned in our interview.
Medically these are known as meclizine, dimenhydrinate, and diphenhydramine. You may know these as Antivert, Dramamine, and Benadryl because as combination antihistamine/anticholinergics they are usually the go to doctors to prescribe when patients report episodes of vertigo. These are vestibular drugs, not intended for prophylactic use, but can be used quickly and are available in pharmacies easily without a prescription.
These are always kind of glossed over when it comes to vestibular migraines, especially in studies. It seems that because they are widely known and seem to help with motion sickness, they are often recommended.
Vertigo — Ent4gp.com
However, antihistamines for migraines may not be the most effective treatment you can find. I personally find these to be an easy place to start, but don’t get discouraged if you don’t see much benefit in stopping a severe vestibular headache attack. Another commonly reported problem is that they can be sedated.
Benzos such as Ativan (Lorazepam), Valium (Diazepam), and Klonopin (Clonazepam) can be used in the lowest doses for the immediate treatment of vestibular headache attacks. My interview with Dr. Beh, we discussed how these are not always the first protocol for attacks, but they can be useful for people who are not helped by other methods such as antihistamines or non-pharmacological drugs.
Dr. Beh says these are useful for patients who also experience increased anxiety about their attacks. Dr. Timothy Hain shares a stepwise vertigo protocol where he starts with Meclizine before switching to some benzodiazepines. He said some benzos seem less sedating but increase dependence. Some are not prescribed because of the high risk of dependence, such as Xanax (alprazolam).
As discussed in this article on the management of migrainous vertigo attacks, the use of these can be controversial due to addiction. This is something Dr. Hain has already visited his website, where he says that the risk can be reduced by maintaining the lowest possible doses and taking them as prescribed. Compensation should not be a concern at these low rates.
Vestibular Migraines And Vertigo Problems Related To Vision
For me, Ativan for vertigo attacks has been very effective to this day. These days I only take it as needed for dizziness, but when I was ready to go off the daily medication, I had no problem with the low dose I was taking. You can review my treatment plan for all the details.
Something I often talk about as part of the treatment for vestibular migraines, is Timolol Eye Drops. Often used in glaucoma patients, these eye drops are basically lower than beta-blockers, which have shown success in preventing migraines.
The interesting twist is that because these can be administered through the eyes or as a nasal spray, the medicine is absorbed into the bloodstream much faster than taking an actual pill.
Again, few studies have shown success using these as an emergency treatment for migraine headaches. I can’t say for sure if this is something I tried at Dr.’s clinic. Beh, or if this is a widely used treatment for vestibular migraine, but it works for me and many friends with headaches.
Light Sensitivity (photophobia) And Vestibular Disorders
One of the interesting recent studies, published by Dr. Shin Beh and Dr. Deborah Friedman, reviewed the benefits of nVNS (which stands for non-invasive vagus nerve stimulation) as an immediate treatment for vestibular headaches.
Your pelvic nerve (pronounced the “Vegas nerve” even though I sometimes have a hard time saying it when it sounds like a party-loving nerve), basically connects your gut to your brain. So naturally it makes sense that some kind of migraine that can affect our gut so much, a stimulant makes sense.
The study tested 18 patients, 14 with VM attacks, and found that vertigo was reduced in 13 or 14 patients. 4 patients with PPPD were also tested and found no improvement.
This nVNS device is also called gammaCore and can be used at home. It is available as both a preventative and an emergency treatment. It used to cost $600 a month, but the price has been reduced to make it more affordable. If your doctor is part of the hospital’s research program, the price is $150 per month for 3 months of treatment, or you can get a similar discount with my code.
Ways I Manage My Vestibular Migraines
I have always wanted to try this tool and it worked for me to try it during the postpartum period when I was struggling with many attacks of vestibular headaches due to lack of sleep. I have found that it is not only effective to reduce dizziness, nausea, and headaches (something new to me after IVF and pregnancy with migraines), but also to help reduce anxiety. The best part was that I could use it as an emergency treatment without impairing my mental clarity or driving ability, as many drugs do.
Each stimulation is 2 minutes long and feels like a gentle hum. Each session is usually 2 stimulations on the same side for a total of 4 minutes. With GammaCore you rent equipment for 3 months at a time.
I’m sharing my journey using gammaCore as a migraine treatment, so don’t miss it if you’re interested. Use dizzycook code for 15% off your gammaCore device, available online through their portal, Vytal.
Another neuromodulation tool used in my clinic is Cefaly. This device stimulates the trigeminal nerve instead of the vagus nerve, so it is placed on the face instead of the neck. This stimulation is usually beneficial for those with any type of headache or sinus pressure.
Vestibular Migraine Presenting With Acute Peripheral Vestibulopathy: Clinical, Oculographic And Vestibular Test Profiles
Cefaly Dual comes with two settings, an emergency setting and prevention. The total cost is $499, and then you buy electrodes that have about 10-20 uses. You can also buy the equipment separately (prevention and emergency treatment) at a discount if you want to use one or the other. Once purchased, the device is yours.
Sessions are 20 and 60 minutes long, but stick to your face to take over.
Cefaly has recently been studied for vestibular migraine attacks, and my neurologist recommended it as another good option.
I haven’t tried Cefaly outside of my doctor’s office yet because it handled really well for me
Dizzy Spells: Kelowna Patient Shares Her Vestibular Migraine Story
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