Vestibular migraine (VM) is a common but underdiagnosed cause of recurrent vertigo. Its heterogeneous manifestations and the lack of validated biomarkers complicate diagnosis, and emerging evidence supports individualized rather than uniform preventive strategies. Among available prophylactic options, venlafaxine and topiramate are two clinically important agents with distinct mechanisms and therapeutic profiles....
✦ The floor
Discussion
Signed responses from readers of the wire.
Clinicians managing vestibular migraine patients may consider phenotype-guided drug selection (venlafaxine vs. topiramate) based on symptom profile, but the evidence base is narrative review level only—no RCT data support definitive preference.
Vestibular migraine is a leading cause of recurrent vertigo seen in audiology and ENT settings, and clearer pharmacological guidance could reduce diagnostic delays and improve patient outcomes.
- 01Vestibular migraine is a common but frequently underdiagnosed cause of recurrent vertigo.
- 02No validated biomarkers currently exist for vestibular migraine diagnosis.
- 03Phenotype-guided selection matches venlafaxine or topiramate to individual symptom patterns.
- 04Evidence base is a narrative review—no RCT data are presented.
- 05Findings are relevant to audiologists and vestibular specialists co-managing dizzy patients.
Phenotype-guided selection of venlafaxine or topiramate improves treatment matching for vestibular migraine.
opinionunclearVestibular migraine is a common but underdiagnosed cause of recurrent vertigo.
studysupported- PMID
- 42591761
- DOI
- 10.3389/fnins.2026.1887023.
- Journal
- Frontiers in Neuroscience
- Publication type
- review
- Evidence level
- 5
- Population
- Patients with vestibular migraine
- Intervention
- Venlafaxine and topiramate selected by phenotype
Primary outcomes
Pharmacological treatment selection guidance for vestibular migraine