A Personal Spin on Migraine-Associated Vertigo Treatments: With few formal guidelines, otolaryngologists use trial and error

Patients with uncontrolled migraine-associated vertigo who had failed other drug treatments found relief with the drug, Dr. Foster said. “But this is really early, so we don’t know yet what the difficulties that we’re going to encounter with the drug are.”

Specialists agreed that other potent drugs like topiramate (Topamax), used to treat seizures in epilepsy patients, should likewise be reserved as a third-line option if other regimens fail. Dr. Goebel cautioned that he’s encountered cognitive problems among some patients on the drug. “You get some word-finding problems, not being able to exactly come up with the word you want to use,” he said.

Similarly, beta blockers like propranolol (Inderal) may be effective but can have a significant downside. “The problem with Inderal as a beta blocker is that if you give it to a younger person, not only does it lower their blood pressure, but it lowers their exercise tolerance,” Dr. Goebel said. Dr. Foster also uses propranolol sparingly, but noted that it can be a good choice for migraine patients with tremor or high blood pressure.

A similarly intense medication like the anti-epileptic and altitude sickness drug acetazolamide (Diamox) may likewise help in more severe cases, Dr. Foster said, such as vertigo with damaging hearing loss. Diamox, Inderal and the occasionally prescribed anti-seizure medication lamotrigine (Lamictal) may not stop headaches, though, potentially requiring such patients to take more than one drug.

Experts have pointed to some limited success with the depression and generalized anxiety disorder drug escitalopram (Lexapro), although the medication is prescribed primarily by neurologists. Another small randomized clinical trial pointed to zolmitriptan (Zomig) as a somewhat beneficial abortive treatment, a rarity among triptans. And an observational study found marginal improvement with the blood pressure medication metoprolol (Lopressor, Toprol) (J Neurol. 2009 256(5):711-716).

The take-away lesson, otolaryngologists say, is that a suite of symptoms still in search of clear categorization may nevertheless respond to a carefully chosen, individually tailored treatment regimen that stops the spinning world of vertigo patients.