Vestibular migraine can produce daily dizziness, but also can occur with episodic, disabling attacks. This fluctuation in symptoms can be stabilized by using preventative medications, which work to prevent attacks before they happen. But as people living with migraine know, occasionally some attacks slip through and we’re left scrambling to get rid of them as quickly as they came on. This is where acute migraine treatments come in.
When used either at the first sign of symptoms or in the midst of a full blown attack, these acute vestibular migraine treatments can either help to completely stop the symptoms or lessen the severity of the attack.
For typical migraine attacks that involve head pain, these are usually analgesics like naproxen (Aleve), ibuprofen, acetaminophen, triptans (migraine specific pain meds), and ergotamines. But what do you take if you don't get head pain with your migraine attacks? Don't worry, you have options!
Jump to:
- Vestibular Migraine Attack Symptoms
- Triptans for Vestibular Migraine
- Antihistamines for Migraine
- Benzodiazepines for Vertigo
- Timolol Eye Drops
- Neuromodulation Devices for Vestibular Migraine
- gammaCore for Vestibular Migraine
- Truvaga
- Cefaly for Vestibular Migraine
- Nurtec for Vestibular Migraine
- Vestibular Migraine Treatment at Home
Vestibular Migraine Attack Symptoms
Very little has been studied on the effect of these with vestibular migraine. Those who live with VM know that not every attack involves a headache or head pain. In fact, up to 50% of people can have vestibular migraine attacks without any headache present. So what kind of symptoms are experienced during a bad vestibular migraine attack?
These can include (but are not limited to):
- Vertigo, which is usually defined as a spinning sensation in clinics, where either you feel as though you are spinning, or the world around you is.
- Continuous dizziness that feels like a foggy brain or lightheadedness, like you're about to pass out.
- Drop attacks - feeling as though you are falling
- False sense of movement - not limited to drop attacks or vertigo, this can be moving from side to side, intense rocking, or like you’re floating
- Alice in Wonderland Syndrome - where objects or body parts appear smaller or larger than what they are.
- Visual distortions and visual snow
- Derealization and depersonalization - a disconnect the environment around you or from your body
If none of these sensations cause pain, but are just are terrifying and debilitating in their own way, how do we stop them? Here are a few new and existing vestibular migraine treatments that can be used acutely.
Triptans for Vestibular Migraine
Up until recently, I truly believed the only effective acute medications for vestibular migraine that existed were benzodiazepines and antihistamines like meclizine. It was previously thought that triptans were ineffective against vertigo, and only worked for migraines with head pain. However, some small studies show a little bit of success. Two randomized trials showed a little bit of evidence supporting the use of rizatriptan and zolmitriptan for vestibular migraine attacks.
In one of the studies rizatriptan showed some promise in 15 subjects who experienced motion sickness due to vestibular issues. 13 of the 15 showed a decrease in motion sickness after taking the rizatriptan, compared to the placebo. However, with an increase in stimulation, the patients did not receive a continued benefit. This seems to be one of the most prescribed triptans for people with vestibular migraine.
In another small study, zolmitriptan showed some benefit in a dosage of 5mg, proving useful in 3 out of 8 vestibular migraine attacks. However, the placebo group showed benefit in 2 out of 9 attacks.
Again, both these studies are limited because of the amount of participants, but when looking at Vestibular Migraine as a whole, there are really only a few small studies to go off in general. This type of treatment is something Dr. Beh is tending to prescribe more, as mentioned in our interview.
Antihistamines for Migraine
Medically these are referred to as meclizine, dimenhydrinate, and diphenhydramine. You may know these are Antivert, Dramamine, and Benadryl because as mixed antihistamine/anticholinergics they are commonly the go-to for doctors to prescribe when patients mention vertigo episodes. These are vestibular suppressants, not meant to be used for prevention, but can be used acutely and are found over-the-counter making them easy to access without a prescription.
These are always kind of glazed over when talking about vestibular migraine, especially in studies. It seems because they are widely known and tend to help with motion sickness, they’re often recommended.
However, antihistamines for migraine may not be the most effective treatment you can find. I personally see these as an easy place to start, but don’t be discouraged if you don’t see a huge benefit for stopping a severe vestibular migraine attack. The other commonly reported drawback is they can be sedating.
Benzodiazepines for Vertigo
Benzos like Ativan (Lorazepam), Valium (Diazepam), and Klonopin (Clonazepam) can be used in the lowest dosages for acute treatment vestibular migraine attacks. In my interview with Dr. Beh, we discussed how these aren’t always the first protocol for attacks, but they can be effective for people who aren’t helped by other methods like antihistamines or non-pharmacological treatments.
Dr. Beh mentioned these tend to be useful for patients who also experience increased anxiety with their attacks. Dr. Timothy Hain shares a stepped vertigo protocol where he begins with Meclizine before transitioning into certain benzodiazepines. He states certain benzos tend to be less sedating but have an increase in dependency. Some are not prescribed due to their high risk of dependency, such as Xanax (alprazolam).
As discussed in this post on managing migrainous vertigo attacks, the use for these can be controversial due to addiction. This is something Dr. Hain has visited previously on his site, in which he says the risk can be decreased by staying with the lowest possible doses and taking as prescribed. Compensation should not be a concern on these low doses.
For me, Ativan for vertigo attacks was extremely effective and still is to this day. These days I just take as needed for dizziness, but when I was ready to wean off daily treatment, I had no issue at the low dose I was taking. You can review my treatment plan with all the details.
Timolol Eye Drops
Something I talk about often as it was part of my own vestibular migraine treatments, is Timolol Eye Drops. Most commonly used for glaucoma patients, these eye drops are basically a lower dosage of beta blockers, which have shown success for migraine prevention.
The interesting twist is that because these can be administered through the eyes or as a nasal spray, the medication is absorbed much faster into the blood stream than taking an actual pill.
Again, a small study showed success with using these as an acute treatment for migraine with head pain. I cannot say for sure if this is just something that I tested in Dr. Beh’s clinic, or if this is a more widely used treatment for vestibular migraine, but it does work for me and quite a few vestibular migraine friends.
No studies have shown the success with this medication and vestibular migraine specifically.
Neuromodulation Devices for Vestibular Migraine
One exciting and recent study, published by Dr. Shin Beh and Dr. Deborah Friedman, reviewed the benefits of nVNS (which stands for noninvasive vagus nerve stimulation) as an acute treatment for vestibular migraine.
Your vagus nerve (which is pronounced “Vegas nerve” although I sometimes have a really difficult time saying that when it just sounds like a nerve that likes to party), basically connects your gut to your brain. So naturally it makes sense that with a type of migraine that can affect our gut so much, a stimulation device for it makes sense.
The study tested 18 patients, 14 with a VM attack, and found that vertigo was reduced in 13 or the 14 patients. 4 patients with PPPD were also tested and found no improvement.
gammaCore for Vestibular Migraine
This nVNS device is also known as gammaCore and can be used at home. It is available as both a preventative and acute treatment. It used to cost $600 a month, but the pricing has been reduced to make it more affordable. If your doctor is a part of a hospital research program, the cost is $150 a month for 3 months of treatment, or you can get a similar discount with my code.
I've always wanted to try this device and it worked out to test it during my postpartum phase when I was struggling with more vestibular migraine attacks due to lack of sleep. I found it to not only be helpful to reduce dizziness, nausea, and head pain (something new for me after IVF and pregnancy with migraine), but also to help bring down my anxiety. The best part was that I could use it as an acute treatment without it compromising my mental clarity or driving ability, like many medications do.
Each stimulation is 2 minutes and feels like a gentle buzz. Each session is usually 2 stimulations on the same side for a total of 4 minutes. With gammaCore you rent the device for 3 months at a time.
I share my journey with using gammaCore as a migraine treatment, so don't miss out if you're interested. Use my code dizzycook for 15% off your gammaCore device.
Truvaga
Truvaga is another nVNS, vagus nerve stimulation, device that is not approved for the treatment of migraine like gammaCore. However, it can help with some of the health issues we need help with like better sleep, less stress, and clearer thinking.
Because it's a one time payment for a device, you pay a set amount for 350 stimulations. This is a better device if you need something occasionally to help with the health issues and not for a preventative migraine treatment. Use my code AFFILIATE10 for a discount.
Cefaly for Vestibular Migraine
Another neuromodulation device that’s being used within my clinic is the Cefaly. This device stimulates the trigeminal nerve instead of the vagus nerve, so it’s placed on the forehead rather than the neck. Typically this stimulation is beneficial for those with any kind of head pain or sinus pressure.
Cefaly Dual comes with two settings, an acute and preventative setting. The total cost is $499, and then you purchase the electrodes which have about 10-20 uses. You can also purchase the devices separately (for preventative and acute treatment) for a discount if you only want to use it for one or the other. Once purchased, you own the device.
Sessions are comprised with 20 and 60 minute sessions, but it sticks to your forehead so you can move around with it.
Cefaly has recently been studied for vestibular migraine attacks, and my neurologist has recommended it to me as another good option.
I have yet to try Cefaly outside of my doctors office because I'm really well managed with my current treatments. Should I have an increase in attacks in the future, I'd be willing to order one. They do give you a 60 day trial period to see if you like it. Get 15% off Cefaly with code dizzycook.
Nurtec for Vestibular Migraine
I have not personally tried any of the new gepants for vestibular migraine, but they are becoming popular because they do not have the risk of rebound like triptans. These work by inhibiting CGRP, which is responsible for head pain signaling in the brain. Generally relief is felt within 2 hours.
Nurtec (rimegepant) is a tablet that has been approved for both the acute treatment and preventative treatment of migraine. Studies have shown it's been helpful for light sensitivity, sound sensitivity and nausea, which can be common with vestibular migraine attacks. There's really no information on Nurtec for vertigo specifically.
While I've heard mixed reviews from vestibular migraine friends, just like any of these treatments it's worth a try! Although Ubrelvy and Reyvow fall into the same category, Nurtec seems to be the most popularly prescribed for vestibular migraine specifically.
Vestibular Migraine Treatment at Home
Some acute vestibular migraine treatments at home that you may already have on hand include:
- Extra Magnesium
- Magnesium Baths, Lotion, or Foot Soaks
- Cognitive Behavioral Therapy, Tapping, or Visualization
- Motion Sickness Bands
- Increase hydration
- Decreasing stress
I know the last one is really difficult - everyone tells us to do this, but it is easier said than done. But truly this can look different for every individual. For me, I had to make a really tough decision to leave my old job as all my other stress relief tactics weren't enough. You know it's probably an issue when your neurologist, nurse practitioner, family, husband, and therapist are all telling you to quit your job.
I also added in massage therapy every two weeks as a scheduled appointment. Financially, it's expensive, but my mental health (and neck) benefitted a ton from this investment. Overall, I believe we know what works best for us, it's just sometimes doing it that's the difficult part.
I hope this post gives you some great ideas to discuss with your physician regarding acute vestibular migraine and vertigo treatments.
Hi Alicia, thank you for all of your content! So many of us are very grateful! I read on one of your posts that you took nortryptaline 20mg. Do you mind sharing if you still take this medicine? Also… did you have any other side effects besides the fatigue that you mentioned as you worked your way from 10 to 20 mg?
Thank you so much! Tracy
Hey Tracy, You're very welcome! I think you're confusing me with someone else? I haven't taken that med, but I have my treatment plan here.
Hi Alicia. You referred to "tapping" but did not describe it anywhere that I can find. What did you mean by that? I'm aware of an Australian physical therapist who does what he calls neural tapping, for tinnitus (it was derived from working with stroke victims).
Thanks!
Hi Paul, I hope Alicia correcte me if I am wrong, but I think she mens EFT. There are lots of tutorials on youtube about it.
Hey Paul, I'm not sure of the exact techniques my therapist used, but EFT does seem similar.
Has anyone tried any of the TJ Nutrition products? ParasymPlus, NAC MAX is my favorite.
Hi Alicia,
Thank you so much for your advocacy and sharing your journey with vestibular migraines. I have been watching you on YouTube and looking at your website. My husband was diagnosed several years ago. Fortunately he doesn’t suffer from chronic symptoms, but he typically has attacks whenever we travel. Motion, dimly-lit or dark places, and very busy visual environments seem to be common triggers. On a trip last fall, the attacks were particularly bad and he struggled not only with dizziness but also with nausea and vomiting, and even passed out once while he was a passenger in a van. He said he could hear me but couldn’t move. It lasted about a minute and then he regained consciousness. I can tell he is so scared about this condition, and it is scary for me as well. Any suggestions on next steps? His doctor and a physiotherapist (who specializes in vestibular disorders) say his case is mild and all he uses is Gravel as a rescue medication, but I worry that our next attempt to travel may bring more suffering. He doesn’t want to stop traveling (and neither do I), but going through another episode fills me with anxiety. Any feedback much appreciated.
Hi Alicia, my neurologist refuses to send me any of the devices because he saids they numb the vagus nerve which is a “band-aide”. Does it numb or stimulate in your experience? I am interested in gamma core. Anything to help with my constant sensation of swaying.
Hmm I haven't heard of that before. It is known as an nVNS (non-invasive vagus nerve stimulation) device. Plus a lot of the devices out there work on other nerves like trigeminal, not the vagus nerve. I find it really odd when a doctor refuses a treatment for their patients like that, especially one that is FDA approved and doesn't come with a lot of the side effects like some of the medications they prescribe. I'd be happy to recommend other doctors that might be more helpful and willing to work with the things you're interested in!
Hello Alicia, I went back to my old neuro and she recommends Gammacore. She also said Cefaly is worth a try. Thank you for your help with this journey. It's been tough. You've been a lifesaver. Take care.
I have some more info on youtube where Dr Beh answers a lot of questions on it and my experience with gammacore. And miles for migraine has some info there too!
Alicia, thank you for your helpful articles and recipes. I've been experiencing VM most of my life (now 52), but only recently diagnosed. Your site is teaching me so much! I am taking only propranolol as I also have essential tremor. I couldn't tolerate Topamax. And I'm just starting physical therapy. In this article I notice a bottle of Afrin in one your your photos. Is that something you use? Is it helpful during a VM episode? Thank you.
Hey! It can be helpful for plane travel with vestibular migraine. You'll just have to run by your physician.
if I'm not having a vestibular migraine attack but I'm going to fly, will using Afrin help keep an attack away? I don't feel any sinus or fullness when not having an attack so I'm curious how would Afrin help? preventive? thank you
It's only if you feel you want to keep your nasal passages clear. I only use it if I feel a little stuffy. It's best to consult with your neurologist for how to use it!
I’m so glad I found your articles Alicia. I’m trying magnesium, riboflavin and Ubliquinol currently. Which so far have not had much relief.
You were recommended from my FB Group I follow for people with Semi-
circular Dehiscence Disorder, in which VM is quite prevalent.
I don’t get the headaches with my VM, but feeling in a fog, not able to find my words, head vibrating -and not being able to stand my own voice (autophony), which makes me nauseous are my symptoms.
The doc has prescribed nortriptylin but I’m quite afraid to take as I respond horribly to meds.
I did try a 1/2 of an .5 ativan today so fingers crossed.
I’d like to try the gammacore excited to try it- anything I can do naturally I’m in!
Thank you again for the support iou are to all of us fellow sufferers
Hey Vickie - not uncommon to experience those symptoms! I hope you find some relief with the tips here.
HI ALICIA,
I was diagnosed with VM in 2017 and they have not been able to BREAK THE HEADACHE SINCE THEN. I do not have pain but I have vertigo and dizziness, I have tried EVERYTHING. Infusions, medicines, machines, massages, diets, botox, nothing works. At times I think I will go crazy, When I walk, people approach me and ask if I need help. It is sad. My head and eyes constantly vibrate, my balance is poor. I cannot exercise because it gets worse. I was wondering if anyone else out there has VM like me and has had any success in managing it? I need help. My doctors are as frustrated as I am. Any suggestions?
Hi Victoria,
I'd recommend an appointment with my neurologist (Dr Beh) and he does do teleconference. All his information is in that post. I'm a little confused because you say you don't have pain but then say you've been trying to break the headache. It's always good if nothing is working to get a second opinion on the diagnosis (it could be another vestibular disorder) or I've also seen it just not be the right combination of things. It can be difficult to find a vestibular expert, so that may help give a new perspective on treatments.
I am assuming that you have tried different SSRI's and/or blood pressure medications. Those have helped me in the past, getting me to totally normal within one day! Have had my current episode of vestibular migraine for 3 months, but am doing balancing on a balance board, which helps some. I am trying difference blood pressure meds right now too (currently taking a beta blocker), but not working. I have been getting VM's for 28 years now, on and off and have not found "a one certain thing" that takes it away, which is something I am working on.
I have been battling a steady progression of symptoms for years now, the only treatment prescription wise I am currently taking is Topimax at 100mg daily. The VM migraines are increasing in prevalence and intensity to the point of being debilitating. The one I am currently experiencing has been ongoing since 1230 last night and it's 730 pm the following evening. The pain, the distortion, the vertigo enough already geez. I have a lot and I mean a lot of other medical issues I am battling at one time and when these get like this, what to turn to I guess is my main question. I don't want to take something that is going to knock me out all I loose the day, my insurance doesn't want to cover Nurtec either. Someone mentioned Botox injections to me the other day, and I thought I had read somewhere about those for migraines. My other concern with taking any more pills is any conflicts with what I am currently taking medication for. So it's a little more complicated here. Yes I have long discussions with my neurologists ( he is only a resident) and I do disagree with him on some things but trying to get into see another neurologist is a months and months long waiting list. So I try to do a lot of Dr. Google like everyone else and go from there. Your thoughts would be appreciated. Thank you.
Erin
Hey Erin, I recommend looking into the timolol drops for the cheapest option with low side effect profile - the only issue seems to be if you have very low blood pressure. I do know some people who still tolerate them with low BP but that's between you and your physician. From there, I would look into cefaly or gammacore. These are more expensive and often not covered by insurance, but as you can see I have some deals here to help. Neither do you need to go through your dr for - both are available online. They will still be far less than nurtec without insurance. No side effects for those as well. I have more detailed posts on timolol and gammacore if you want more info on those.
Hi Alicia, This is an excellent overview. I personally use the Timolol drops and the Cefaly Device 2x daily as preventative with good results. Fortunately I don’t have headaches with my VM. I do have PPPD and I feel it’s made a significant improvement. Thanks for making the information so readable. You’re the BEST!
Awesome, I'm so happy to hear this is all helping! 🙂
Hi Alicia! Thank you so much for this as well as for all the other valuable information you post for us migraineurs. You were my starting point and steady point of reference when I need help.
A question about massage. What kind of massage do you find helpful and what do we need to be careful about when selecting a professional for this?
Thank you very much
Yioula Kyriacou
Hey Yioula, Thanks for the kind words. I would recommend this post on massage therapy for migraine! I will say that there are a lot of bad massage therapists out there so I'd look for someone who has a long time in the field, or has potentially taught other massage therapists. Often you'll find these people working on their own rather than in spas. Your neurologist or chiropractor may also have someone in mind! I hope that helps a bit!
Hi! Thank you for this. My grandmother, mom, myself and now my 15 year old daughter have vestibular migraines. My daughter is the only one that presents with headaches after her vertigo episode. Did the Gammacore help with your vertigo or just head pain? I don’t have the headaches so I was wondering how this would help me. The 2 devices speak about the migraines but never address the vertigo. Thanks!
So I haven't actually had a vertigo episode since I gave birth, and before that it had even been a few years. I haven't actually tested it during an attack! For me, it relieves dizziness and brain fog. Like the other day I had a mild attack in the morning and it was gone by 2pm.
Gammacore is the only one that has been studied officially for vertigo. I believe the study is linked in the post!