By Alicia Wolf
Patients with vestibular disorders may choose to incorporate supplements into their treatment plan, either to support their prescription medications or as non-pharmaceutical alternatives that can help reduce their symptoms and improve their overall wellness.
Many natural supplements are backed by scientific research and have been found to be helpful in decreasing vestibular migraine days, easing tinnitus, lowering inflammation, or reducing anxiety. While these treatments may be “natural,” it does not mean they are safe for everyone. Always consult your doctor before beginning any new treatment plan, as some supplements may interact with prescription medications.
Supplements for Vestibular Migraine and Persistent Postural Perceptual Dizziness (PPPD)
The following supplements are the most commonly recommended for migraine, based on research. Since vestibular migraine and PPPD can occur together, these supplements are usually prescribed for both. However, if PPPD is caused by a different vestibular disorder, recommendations may vary.
It is challenging and expensive to measure magnesium accurately through blood tests, making it difficult to identify low magnesium in the brain. Studies have found that many people with migraine have low levels of magnesium in the brain and spinal fluid. This is why supplementation is important for those with migraine, even if a deficiency is not detected.
A daily dose of between 400mg-800mg of magnesium is recommended for migraine prevention by most clinics, including Johns Hopkins. Magnesium oxide is the most widely recommended, was used in studies, and is inexpensive and readily available. One unfortunate side effect for some, however, is diarrhea. Because high doses are recommended for migraine prevention, a more easily absorbed form like magnesium glycinate may be better tolerated. Different types of magnesium may be recommended for different symptoms.
A 2004 European study found that migraine days were cut in half after three months of daily use of 400mg B2 Riboflavin. In addition, the number of migraine-abortive medications was also significantly reduced. Riboflavin was found to be well-tolerated by the participants in the study. There are also many natural sources of riboflavin that can be added to a healthy diet, including eggs, lean protein, green vegetables, and fortified cereals and breads.
Two small but effective studies have shown that CoQ10 may help with migraine prevention. In one study, patients took 150mg of CoQ10 daily for three months and over half of them experienced a 50% reduction in migraine days without side effects. The other study used 100mg three times a day and compared it with a placebo. The CoQ10 was three times more effective at reducing migraine attacks than the placebo, yet some noted stomach upset as a side effect. Some of the side effects may be avoided by splitting the dosage throughout the day. CoQ10 may interact with some medications.
In a 2014 study, ginger was found to be as effective as sumatriptan (Imitrex) in migraine patients without aura. Within two hours, pain severity was lessened. It is unclear whether this supplement helps with vestibular migraine dizziness without pain. A quarter of a teaspoon of ginger powder is the recommended dosage, taken at the first sign of an attack.
An extremely small study of eight patients showed that their headaches were unchanged, yet the frequency of headaches increased significantly when stopping feverfew to switch to the placebo. Some studies showed feverfew to be slightly more effective than the placebo. Symptoms of nausea and vomiting were also reduced. Other studies have shown it to not be effective for migraine prevention. Other than helping with nausea, there’s no clear research on if this will help vestibular symptoms.
Vestibular Neuritis, BPPV, and Meniere’s
Low levels of vitamin D have been found in patients with vestibular disorders such as benign paroxysmal positional vertigo (BPPV), Meniere’s disease, and vestibular neuritis. A few reports have shown supplementation to be beneficial for preventing BPPV attacks and Meniere’s symptoms. Dosage should be discussed with your doctor, and should be adjusted based on your current blood levels of Vitamin D.
Vestibular Neuritis & Meniere’s Disease
A naturally occurring amino acid with anecdotal evidence for reducing tinnitus and vertigo.
There is some research that points to gingko being helpful for enhancing cognitive function and improving memory loss. Some patients with tinnitus find it helps, while other research points to it being ineffective. It also thins the blood and is usually not recommended to be taken with other blood thinners. Preparations in the US vary, so it is important to look for labeling EGb 761, which is extracted from the leaves. Most studies of Ginkgo use between 120-240mg a day. This could be effective for patients with multiple vestibular disorders.
Although the research for this supplement isn’t strong, it does appear to be helpful for some patients with Meniere’s disease, particularly those with tinnitus as a symptom. This supplement is fairly well-tolerated.
Mal De Debarquement Syndrome (MdDS) and Acoustic Neuroma
Currently there are no vitamin or supplement recommendations for Mal de Debarquement Syndrome (MdDS) or acoustic neuroma.