When vestibular migraine attacks reach a frequency of three or more per month and carry a meaningful negative impact on daily quality of life, the evidence supports a structured preventive treatment strategy rather than acute management alone.
This protocol addresses patients with vestibular migraine who experience three or more attacks per month and in whom those attacks significantly impair quality of life — the combination that signals the need for systematic prophylaxis.
The recommended strategy involves prophylactic monotherapy with one of several agents supported by controlled-study evidence, introduced at a low starting dose and titrated slowly. Which agent is selected, and the full rationale behind that choice, are detailed in the complete protocol.
Prophylaxis is considered effective when it achieves a reduction in migraine attack frequency of 50% or more, evaluated two months after the patient reaches the highest tolerated dose.
DOI: 10.1177/2514183X1882337