Recommended first-line treatments for vestibular migraine:
Vestibular migraine is often treated similarly to standard migraine, as there is a lack of specific high-quality evidence for its prophylactic and acute treatment.
First-line prophylactic treatments include propranolol and topiramate, which are recommended for episodic or chronic migraine and can be considered for vestibular migraine patients if not contraindicated.
Amitriptyline may also be considered for prophylaxis depending on patient preference, comorbidities, and risk of adverse events.
Non-pharmacological management such as lifestyle modifications (stress management, good sleep hygiene, hydration, regular meals, exercise, mindfulness) and avoidance of known migraine triggers should be advised.
Symptomatic drug treatments licensed for nausea, vomiting, and vertigo may be used pragmatically for acute symptoms, but specialist advice should be sought if symptoms deteriorate.
Overall, treatment decisions should be individualized, and specialist referral is advised if diagnosis is uncertain or symptoms worsen.
References: NICE CKS, NICE CKS, NICE CG150