Research in Vestibular Science

Review Article

Preventive medical treatment of vestibular migraine: a practical review: Jae-Hwan Choi, Kwang-Dong Choi, Eun Hye Oh, Seo-Young Choi; Res Vestib Sci. 2025;24(1):20-26. Published online March 14, 2025; DOI: https://doi.org/10.21790/rvs.2024.024

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Abstract PDF: This review explores the medical treatment options for vestibular migraine (VM), focusing on preventive strategies and their evidence-based efficacy. VM, characterized by recurrent dizziness associated with migraine, requires tailored management due to its distinct clinical features and pathophysiology. Most VM treatments are derived from migraine management protocols, utilizing medications such as BBs, CCBs, and antiepileptic drugs. Meta-analyses revealed that flunarizine, propranolol, and venlafaxine significantly reduced vertigo frequency and Dizziness Handicap Inventory scores, although the evidence was limited by small sample sizes and methodological inconsistencies. Flunarizine showed benefits in reducing vertiginous episodes but was less effective for headache. Venlafaxine demonstrated additional improvements in depressive symptoms. Observational studies also indicated potential efficacy for propranolol and valproate. Emerging therapies, such as calcitonin gene-related peptide monoclonal antibodies, showed promise in improving both vestibular and headache symptoms in small-scale trials, though further evidence is needed to establish their role in VM management. The selection of preventive medications for VM should be individualized, considering both the frequency and severity of vestibular and headache symptoms, as well as patient comorbidities and preferences. While existing migraine protocols offer some guidance, the need for VM-specific treatment strategies remains critical.

Review

Risk of Falls in Dizzy Patients: Sung Kyun Kim, Gi Jung Im; Res Vestib Sci. 2017;16(1):10-16. Published online March 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.1.10

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Dizziness is the most common symptom in elderly patients and has been identified as a risk factor for falls. They can affect objectively the ability to achieve a stable gaze, posture, and gait. Research on the relationship between vestibular hypofunction and falls in elderly people has been rarely performed and the evidence is controversial. Because falls result from various combinations of many factors, validated tools should be used for assessment of falling. Many of the tests and numerous parameters associated with the risk of falling have already been introduced, however guidance on which test is most appropriate for use in a specific setting still lack in the medical community. Therefore, developement of comprehensive fall risk management guideline and assessment tool including physical, psychosocial, environmental factors are necessary to prevent falls in the elderly. Establishment of validity and reliability for relationship among several vestibular function test are more important to evaluate efficiently risk of falls in the dizzy patients. Also we can expect that decreasing risk of fall when conduct the developement of additional customized intervention method using verified assessment tools.

Citations

Citations to this article as recorded by

Exploratory fall risk and preventive intervention in acute vestibular neuritis
Euyhyun Park, Sung Kyun Kim, Jinnyeong Jang, Hye Min Han, Jae Jun Song, Sung Won Chae, Hak Hyun Jung, Gi Jung Im
Journal of International Medical Research.2021; 49(9): 030006052110442. CrossRef

Clinical Trial

Treatment of Vestibular Migraine: Byung Kun Kim; Res Vestib Sci. 2012;11(4):111-115.

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Abstract PDF: Although vestibular migraine is considered to be the most common cause of non-positional recurrent vertigo, well designed clinical trials for the treatment of vestibular migraine are not yet available. Management includes dietary and lifestyle modifications and medications. Since treatment for vestibular migraine generally follows the recommended treatment of migraine, most drugs are also used for the prevention of migraine. In this review, preventive treatment with beta blockers, calcium channel blockers, antiepileptic drugs, antidepressants, acetazolamide and triptans are described. Nonpharmacological management such as diet, sleep and avoidance of triggers are also recommended for vestibular migraine.

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