Journal of Neurology

, Volume 256, Issue 5, pp 711–716 | Cite as

Vestibular migraine: a critical review of treatment trials

  • Majid Fotuhi
  • Braeme Glaun
  • Susan Y. Quan
  • Tzipora Sofare


Vestibular migraine (VM), also known as migraine-associated vertigo, is a common cause of dizziness in adults. We performed a comprehensive literature search regarding treatment for VM or migraine-associated vertigo during the period of 1990–2008 and used, individually or in combination, the search terms VM, migraine-associated vertigo, migraine-associated dizziness, migrainous vertigo, migraine and vertigo, migraine and disequilibrium, and headache and vertigo. We found nine publications that address treatment strategies for VM. One small randomized clinical trial found some benefit from the use of zolmitriptan for abortive treatment of VM. The other eight observational studies showed marginal improvement with migraine prophylactic medications such as nortriptyline, verapamil, or metoprolol. Until more specific treatment options become available, patients with VM need to be managed with similar prophylactic and abortive strategies as those used for migraine in adults.


Vestibular migraine Migraine-associated vertigo Migraine Vertigo Dizziness Headache 



We thank Dr. David Newman-Toker for his thorough and extensive review of the manuscript. His thoughtful comments are greatly appreciated.


  1. 1.
    (1988) Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the International Headache Society. Cephalalgia 8(Suppl 7):1–96Google Scholar
  2. 2.
    Baloh RW, Foster CA, Yue Q, Nelson SF (1996) Familial migraine with vertigo and essential tremor. Neurology 46:458–460PubMedGoogle Scholar
  3. 3.
    Bikhazi P, Jackson C, Ruckenstein MJ (1997) Efficacy of antimigrainous therapy in the treatment of migraine-associated dizziness. Am J Otol 18:350–354PubMedGoogle Scholar
  4. 4.
    Bisdorff AR (2004) Treatment of migraine-related vertigo with lamotrigine: an observational study. Bull Soc Sci Med 2:103–108Google Scholar
  5. 5.
    Carmona S, Settecase S (2005) Use of topiramate (Topamax) in a subgroup of mirgraine-vertigo patients with auditory symptoms. Ann NY Acad Sci 1039:517–520PubMedCrossRefGoogle Scholar
  6. 6.
    Dieterich M, Brandt T (1999) Episodic vertigo related to migraine (90 cases): vestibular migraine? J Neurol 246:883–892PubMedCrossRefGoogle Scholar
  7. 7.
    Eggers SD (2007) Migraine-related vertigo: diagnosis and treatment. Curr Pain Headache Rep 11:217–226PubMedCrossRefGoogle Scholar
  8. 8.
    Hufner K, Barresi D, Glaser M, Linn J, Adrion C, Mansmann U, Brandt T, Strupp M (2008) Vestibular paroxysmia: diagnostic features and medical treatment. Neurology 71:1006–1014PubMedCrossRefGoogle Scholar
  9. 9.
    Johnson GD (1998) Medical management of migraine-related dizziness and vertigo. Laryngoscope 108:1–28PubMedCrossRefGoogle Scholar
  10. 10.
    Kroenke K, Price RK (1993) Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. Arch Intern Med 153:2474–2480PubMedCrossRefGoogle Scholar
  11. 11.
    Maione A (2006) Migraine-related vertigo: diagnostic criteria and prophylactic treatment. Laryngoscope 116(10):1782–1786PubMedCrossRefGoogle Scholar
  12. 12.
    Neuhauser H, Lempert T (2004) Vertigo and dizziness related to migraine: a diagnostic challenge. Cephalalgia 24:83PubMedCrossRefGoogle Scholar
  13. 13.
    Neuhauser H, Leopold M, von Brevern M, Arnold G, Lempert T (2001) The interrelations of migraine, vertigo, and migrainous vertigo. Neurology 56:436–441PubMedGoogle Scholar
  14. 14.
    Neuhauser H, Radtke A, von Brevern M, Lempert T (2003) Zolmitriptan for treatment of migrainous vertigo: a pilot randomized placebo-controlled trial. Neurology 60:882–883PubMedGoogle Scholar
  15. 15.
    Neuhauser HK, von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T (2005) Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology 65:898–904PubMedCrossRefGoogle Scholar
  16. 16.
    Reploeg MD, Goebel JA (2002) Migraine-associated dizziness: patient characteristics and management options. Otol Neurotol 23:364–371PubMedCrossRefGoogle Scholar
  17. 17.
    Savundra PA, Carroll JD, Davies RA, Luxon LM (1997) Migraine-associated vertigo. Cephalalgia 17:505–510 (discussion 487)PubMedCrossRefGoogle Scholar
  18. 18.
    Silberstein S, Diener HC, Lipton R, Goadsby P, Dodick D, Bussone G, Freitag F, Schwalen S, Ascher S, Morein J, Greenberg S, Biondi D, Hulihan J (2008) Epidemiology, risk factors, and treatment of chronic migraine: a focus on topiramate. Headache 48(7):1087–1095PubMedCrossRefGoogle Scholar
  19. 19.
    Waterston J (2004) Chronic migrainous vertigo. J Clin Neurosci 11(4):384–388PubMedCrossRefGoogle Scholar
  20. 20.
    Whitney SL, Wrisley DM, Brown KE, Furman JM (2000) Physical therapy for migraine-related vestibulopathy and vestibular dysfunction with history of migraine. Laryngoscope 110:1528–1534PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Majid Fotuhi
    • 1
  • Braeme Glaun
    • 2
  • Susan Y. Quan
    • 3
  • Tzipora Sofare
    • 2
  1. 1.Center for Balance, Dizziness, and VertigoLifeBridge Health Brain & Spine InstituteBaltimoreUSA
  2. 2.LifeBridge Health Brain & Spine InstituteBaltimoreUSA
  3. 3.Department of Internal MedicineJohns Hopkins University School of MedicineBaltimoreUSA

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