Shin Beh, MD, Center For Vestibular & Migraine Disorders, Frisco, TX, discusses the use of non-pharmacological therapies for vestibular disorders in patients with headache. Evidence suggests that acupressure on the wrist can prevent nausea and motion sickness, which are associated with vestibular disorders. Nutraceuticals such as magnesium, feverfew, coenzyme Q10, and vitamins D and B12 have also been shown to help reduce symptoms. Another non-pharmacological option is neuromodulation, where devices stimulate peripheral nerves to alter brain function. This could be non-invasive vagus nerve stimulation, such as the gammaCore device, or external trigeminal nerve stimulation. These techniques are not yet FDA-approved for vestibular disorders but are FDA-approved for cluster headache and migraine, respectively. Studies have suggested that neuromodulation helps vestibular migraine rescue, and anecdotal evidence shows that they may be able to prevent migraines. As of now, the main issue with neuromodulation is the high cost, which many US-based insurance companies do not cover. This interview took place at the American Headache Society 2023 meeting in Austin, TX.
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