90. Acute Treatments for Vestibular Migraine

In this episode, we break down the essential tools and strategies for managing acute Vestibular Migraine attacks. Whether you're newly diagnosed or a seasoned vestibular warrior, understanding your options can make all the difference in navigating sudden flares. We’ll cover:💊 Acute medications: what they are, how they work, and when to use them🚨 Rescue meds: fast-acting options for when symptoms spiral🧰 Your vestibular toolkit: non-medication tools like ginger chews, ice packs, blue light glasses, and more to help ease symptoms on the spot You don’t have to ride it out alone. Let’s get grounded together—with practical, proven ways to help you feel more in control. Links/Resources Mentioned: Vestibular Group Fit (code GROUNDED at checkout!)  Amazon Storefront More Links/Resources: ⁠The 4 Steps to Managing Vestibular Migraine ⁠The PPPD Management Masterclass⁠ ⁠What your Partner Should Know About Living with Dizziness⁠ ⁠The FREE Mini VGFit Workout⁠ ⁠The FREE POTS - safe Workouts⁠ ⁠Vestibular Group Fit (code GROUNDED at checkout for 15% off your first subscription cycle!) ⁠ Connect with Dr. Madison: ⁠@⁠⁠TheVertigoDoctor ⁠ ⁠@TheOakMethod⁠ ⁠@VestibularGroupFit⁠ Connect with Dr. Jenna @dizzy.rehab.therapist  Work with Dr. Madison 1:1, Vestibular Rehabilitation Therapy Vestibular Group Fit Small Group Coaching (offered throughout the year, sign up for our email list to learn when!) Why The Oak Method? Learn about it here! Love what you heard? Reviews really help us out! Please consider leaving one for us.  This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

Episode Transcript

(00:04):
Hey, friend. Welcome to Grounded, the vestibular podcast.
I'm doctor Madison Oak, aka the vertigo doctor.
I am the vestibular physical therapist who is
here to help you with all things dizziness,
imbalance, and vertigo.
In this podcast, we explore the fascinating world
of vestibular disorders. Come with me as we
dive into the journey to discover the mysteries
of dizziness, the brain, inner ear, and the

(00:26):
balance mechanisms that keep us grounded.
Whether you've been managing your dizziness for one
day or for twenty five years, we are
going to get real about what it takes
to manage dizziness, handle the anxiety cycle, and
thrive, not just survive with your vestibular disorder.
First, I want to remind you that this
is never medical advice. Remember this podcast is
for informational purposes only and may or may

(00:46):
not be the best fit for you and
your personal situation.
It shall not be construed as medical advice.
The information and education provided here is not
intended or implied to supplement or replace professional
medical treatment, advice, and or diagnosis. Always check
with your own physician, medical professionals, and health
care team before trying or implementing any information

(01:07):
found here. Meet me in your coziest chair
while we navigate the highs and lows and
the twists and turns of the vestibular universe.
Welcome to Grounded.
Let's dive in.
Hello, and welcome back to Grounded. My name
is doctor Madison Oak. And today, we are
talking all about

(01:28):
acute
migraine treatment.
That being said,
I first wanna start with a win as
always. This week's win of the week is
by Diana.
This one's really quick, but I absolutely love
it. She says, I made it back to
work after being on leave of absence for
six weeks, back full time, taking each day
as it comes. Then I have an update
since she posted this, and she's been back

(01:49):
for not one, but three
weeks,
which I am literally obsessed with and so
excited slash thrilled about. So congratulations to you.
Getting back to work is not a joke,
and bringing your toolkit is so needed and
also raising your threshold. So there are a
lot of steps that come with this. It's
not just like, I'm gonna go sit back

(02:10):
in that chair. Right? I think we all
probably know that.
There are a lot of things that you
do need to think about and do when
you return to work. So congrats, Diana. I'm
really excited and I can't wait to see
kind of all the things you do next.
Alright. Let's get into the episode. Today, we
are talking again about acute
medication
slash treatment for migraine.

(02:33):
I get a lot of questions
asking, do I need to go on medication
for migraine or vestibular migraine treatment? And I
think when people are asking this, they're asking
me, usually about, like,
SSRIs,
SNRIs,
TCAs,
acute,
preventative
medications
rather than acute medications. Remember, there are three

(02:56):
classifications.
We're not gonna go deep into them, but
preventative, acute and rescue. Preventative, you take daily.
Acute, you take for aborting and attack. It
is important because medication under use headache is
also a thing. And then there are rescue
medications for when those two things, like, don't
work, they break through, and then you're like,
I need something to save how I'm feeling

(03:17):
right now. That is what a rescue medication
is for.
Now,
not only do we have to consider
acute medication,
but we also have to consider your entire
toolkit when it comes to having migraine attacks
and vestibular migraine attacks.
When I talk about a toolkit, the we
have other episodes about toolkit. I am talking

(03:39):
about everything that you could use possibly
to help you treat a migraine attack from
shoulder massage
thing off of Amazon
to Rouxel essential oils to cephaly, Truvaga, gammaCore,
Norivio.
Like,
you name it, it can go in your
toolkit.
Now usually what I tell people in vestibular

(04:01):
group fit is that you
and who I see one on one and
I talk about on Instagram, honestly, you need
more than one thing in that toolkit.
Because
chances are, even if you do something perfectly,
or everything perfectly I should say, you can
and probably will at some point in your
life still get an attack.
Now there's this thing called medication under use

(04:23):
headache, and I talked about this, before in
group a little bit. We have some, like,
how to's about it that are coming out
soon. But, ultimately,
medication under use headache is similar to medication
overuse headache. It's when you're not taking
enough
medications
or using
things that help enough to treat your actual

(04:44):
attacks.
I was talking about this with a client
earlier this week who was like, I'm so
against medication, but also I've taken like a
lot of, classes and programs all about, like,
dizziness and people have told me that, like,
I did this to myself and I just
need to, like, try harder and think harder
and think my way out of it.
You cannot simply think your way out of

(05:05):
migraine. You can't sit there and hope and
be like, I want my brain to fix
itself. That is not how our brains work.
When we do not appropriately treat migraine attacks,
migraine,
the disorder gets worse because your brain ends
up going through more and more central sensitization
at the end of the day. We obviously
do not want this. We obviously want our

(05:28):
brain to be less sensitive to triggers and
things. And so therefore
appropriately treating your brain and your attacks to
hopefully bring it back down to baseline
is essential.
So typically, the first thing that you are
prescribed when it comes to a prescription is
going to be atriptan,
sumatriptan,
rizatriptan,
naretriptan, all those things. Again, I am not

(05:49):
a medical doctor. I am not ever prescribing
these things. These are just the things that
I see prescribed, honestly, to my patients and
clients.
And sometimes they work and sometimes they don't.
The thing
about this is that there is something called
step therapy
that your insurance goes through, basically, when you
are prescribed medication
that isn't automatically covered through your insurance plan.

(06:10):
And most
or many migraine medications
are under this because migraine, like, specific
medications like the gPants or the CGRPs,
the Nurtec, UBrevlys,
Amavigs of the world,
are more expensive
than triptans because they're so commonly prescribed and
they've been around for a long time and

(06:30):
things like that,
that it's harder to,
get them prescribed to you and get your
insurance to actually go ahead and approve them.
So, unfortunately,
call your senators, call your congresspeople
because they are trying to get rid of
step therapy if they haven't already. I don't
think they have yet, but I know that
they are trying,

(06:50):
two,
so there are
just things like hoops you basically have to
jump through. So triptans, if they don't work
for you, it doesn't mean the next thing
isn't gonna work for you. And I also
want you to know that just because sumatriptan
doesn't work, doesn't mean rizatriptan
isn't going to work. Remember, we're just talking
about acute medications that treat
attacks. The next thing that I see work

(07:11):
pretty well for
vestibular migraine is timolol eye drops, t I
m o l o l. That is a
beta blocker. It is an eye drop medication.
Again, I do see this work relatively well
for people who have,
vestibular migraine. You can ask your doctor about
it. There is research to back it up.
Not a ton, but it is a thing.

(07:31):
You have the G pants. So again, your
Nurtecs, Ubrevlys, Cuculiptas
of the world. There are both
preventative versions of this and acute versions for
of this. You can use it for either
depending on you and your personal needs and
what you talk about
with your doctor. They're the Ditans. I don't
see these prescribed as much, but they are
indeed prescribed.

(07:52):
And then there's your neuromodulation devices. These are
kind of like our big classes, and we
go more into this in group, obviously. We
talk, like, way I wouldn't say specifically, I
can't tell you what to take. It's not
my job, but I can kind of troubleshoot
this more with you in group. So if
you have more questions, that is where to
find me. And
things like cephaly,
gammaCore,

(08:13):
Truvaga,
Nuryvio,
I think that's all of them. Those are
the neuromodulation devices for migraine attacks themselves. They
can also be used as migraine abortives, which
is really cool. So definitely give those a
shot. They have little to no side effects.
No side effects for most people.
They are overall pretty safe and

(08:33):
work great. So I recommend people, and they
all all of them besides, I think, gammaCore
and Norivio. So Truvaga and Cephaly have an
excellent return policy. So that can be super
helpful too. Then you have your vestibular suppressants.
The things
and nausea suppressants that I am about to
list
are not acute medications for migraine. They are

(08:56):
rescue medications for migraine or vestibular symptoms in
general.
Meclizine
or diphenhydramine.
Those are vestibular suppressants and anti nausea medications,
not migraine medications.
You could also try ondensitron,
which is Zofran, that's an anti nausea medication.
Benzodiazepines,

(09:17):
like lorazepam, clonazepam,
Xanax, Klonopin, things like that.
These should be typically used short term only,
rarely, as a rescue medication. Again, this is
not an acute medication. It is not aborting
an attack, which is ultimately what you're trying
to do. These ultimately just mask your symptoms
like putting a band aid on something you're
not helping necessarily to

(09:38):
not have central sensitization, which is the goal.
That's not what's gonna happen. Other things that
you can use acutely
are going to be things like cooling packs,
resting in the dark, hydration, essential oils, ginger,
magnesium,
electrolytes,
Avolux glasses. Code vertigo doc for discount on
those. They're great. Loops.
I have an Amazon storefront. Maybe I can

(09:59):
link it below.
All of these things
are really helpful acute strategies, and I urge
people to use as many as they can.
I have way longer lists of things in
vestibular group fit. There's a whole course on
toolkit building, acute management,
all of the things, and then medication overuse
and underuse headache, which you both of which

(10:20):
you need to be careful about.
So if you have questions about this,
please let me know. But honestly, I can't
answer most questions unless you are a member
of group. If you would like to be
a member of group,
there is going to be a sale at
the very end of this month.
I'm just gonna tell you right now, honestly,
June,
if you want to join group.

(10:41):
I will tell you the discount code later,
but do be prepared for that. Or you
can join today and use the code grounded
for 15% off your first subscription cycle. So
if you have questions about that, honestly, that's
where best to find me.
I love you, and I will see you
on the next episode of Grounded.
Thanks so much for listening. If you liked
this episode, head to the show notes and

(11:03):
take the free vestibular migraine and persistent postural
perceptual dizziness master classes. If you're interested in
undoing your chronic dizziness and feeling better faster,
join us in vestibular group fit using code
grounded, all caps, for 15% off.
Find me on Instagram at the vertigo doctor
and doctor jenna at dizzy dot rehab dot
therapist.
Your success story begins today. Dizziness doesn't have

(11:25):
to be forever, so let's get you the
right tools to thrive.
Remember, rate review and subscribe to this channel
wherever you are listening so we can keep
getting great guests and reaching new vestibular warriors.
Love you, and see you next time on
Grounded.