First-Line Treatment of Vestibular Migraine

Vestibular migraine is characterised by episodic vestibular symptoms — vertigo, dizziness, or imbalance — occurring in association with migraine. Acute attacks, particularly those of mild to moderate intensity, require a structured first-line pharmacological approach aimed at rapid headache relief.

Clinical Situation

This protocol covers the initial pharmacological management of acute vestibular migraine attacks. It is the recommended starting point and does not require a prior treatment attempt. The focus is on effective control of mild to moderate attack severity.

Treatment Approach

First-line management centres on oral analgesic or anti-inflammatory medication. Where significant nausea or vomiting is present, a targeted anti-emetic agent may be used separately. The full structured regimen — including which agents apply, in what sequence, and under what clinical conditions — is available in the complete protocol.

Treatment Goal

The primary clinical target is a meaningful reduction in migraine headache within 2 hours of taking the medication.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1177/2514183X1882337

Analgesics like acetylsalicylic acid and non-steroidal anti-inflammatory drugs (NSAIDs) are effective in the treatment of migraine.
Mild and moderate migraine attacks should be treated initially with these substances.
Anti-emetics like metoclopramide or domperidone are effective in the treatment of nausea and vomiting during a migraine attack.
Prokinetic and anti-emetic medications should generally not be combined with analgesics or triptans but used for targeted treatment of severe nausea or vomiting.
No significant difference could be observed between the dosages 200 mg, 400 mg and 600 mg ibuprofen for the primary endpoint headache reduction 2 h after taking the medication.

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