When vestibular migraine occurs in the context of chronic migraine, the clinical picture calls for a preventive strategy specifically suited to this combination. The co-presence of chronic migraine is a key factor guiding both therapy selection and success criteria.
This protocol is for vestibular migraine in patients with chronic migraine. Evidence indicates that certain preventive agents are effective in chronic migraine, with or without concurrent medication overuse.
Management is centred on oral prophylactic therapy, introduced with a gradual titration to an effective target dose. The complete regimen — including the specific agent, titration schedule, and target dose — is detailed in the full structured protocol.
Prophylaxis is considered effective when it achieves a reduction in migraine attack frequency of 50% or more.
DOI: 10.1177/2514183X1882337
Topiramate and onabotulinumtoxinA are effective in chronic migraine with or without medication overuse.
The initial dosage should start slowly with 2 × 12.5 or 2 × 25 mg and a dose of 2 × 50 mg (if necessary up to 2 × 100 mg) per day as final target dose.
Migraine prevention is considered effective when it achieves a reduction of the migraine attack frequency of 50% or more.
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