What are some of the preventive treatments for vestibular migraine?


Some of the preventive medications used to prevent migraine are also used in treating vestibular migraine. However, there are certain calcium channel blockers that are used to treat vestibular migraine that are not used to treat typical migraine.


“... for someone who's having symptoms almost on a daily basis, if not on a daily basis, usually it's going to require preventive management. It's going to require a maintenance medication that he would take every day. Sometimes it's like many other conventional preventive treatments we use for migraine. There are four approved in the United States: topiramate, divalproex sodium … So, sometimes we use typical preventive medications. Sometimes, for vestibular migraine, we'll use medications we typically don't use to prevent episodic migraine that isn't associated with vertigo. Some examples of that: There's a medication called acetazolamide. It's an old medication, but we use that for patients with vestibular migraine. There's another medication called verapamil. Verapamil is a calcium channel blocker, sometimes used for patients with high blood pressure. But verapamil, we think, is probably more effective for vestibular migraine and some other unusual migraines that I think we may talk about, than it is for typical migraine.
“Another medication, which unfortunately we don't have in the United States but is available in many countries around the world, is a medication called flunarizine. It, too, is a calcium channel blocker, but it can be very effective for the vertigo associated with migraines.”


When treating vestibular migraine, some of the same preventive medications used to prevent typical migraine are used. Examples of these medications include topiramate and divalproex sodium. There are also medications used that are not used in the treatment of typical migraine, including certain calcium channel blockers, such as verapamil and flunarizine (although flunarizine is not approved for use in the United States). Acetazolamide, which is a diuretic, is also used in treating vestibular migraine.

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David Dodick, MD

Professor (Emeritus)
Mayo Clinic, Arizona

David Dodick, M.D., FAAN, is a professor of neurology at the Mayo Clinic College of Medicine and Science in Scottsdale, Arizona. He is the director of the headache program and the sports neurology and concussion program at Mayo Clinic in Arizona. He is an adjunct professor in the department of neurosciences, Norwegian University of Science and Technology. Dr. Dodick is board certified by the Royal College of Physicians and Surgeons of Canada and the American Board of Psychiatry and Neurology (ABPN). He also holds United Council for Neurologic Subspecialties certification in headache medicine and ABPN certification in vascular neurology.

Dr. Dodick has authored more than 380 peer-reviewed publications and authored/edited 10 books. He is the chair of the American Migraine Foundation, chair of the American Academy of Neurology (AAN) Annual Program Concussion Committee, co-director of the American Registry of Migraine Research, chair of the International Registry for Migraine Research, chair of the International Headache Society Global Patient Advocacy Coalition, co-director of the Annual AAN Sports Concussion Conference, president-elect of the International Concussion Society, immediate past-president of the International Headache Society, former editor-in-chief of Cephalalgia, and past-president of the American Headache Society.