What lifestyle modifications can I suggest to patients to help manage vestibular migraine symptoms?

To help patients manage vestibular migraine symptoms through lifestyle modifications, suggest the following:

• Identify and avoid migraine triggers: Common triggers include stress, lack of sleep, certain foods, dehydration, and hormonal changes. Encouraging patients to keep a headache and vertigo diary can help identify personal triggers to avoid ¹.
• Maintain regular sleep patterns: Consistent sleep hygiene can reduce migraine frequency and severity ¹.
• Manage stress: Stress reduction techniques such as relaxation exercises, mindfulness, or cognitive behavioural therapy may help reduce vestibular migraine episodes ¹.
• Encourage regular physical activity: Moderate exercise can improve overall well-being and may reduce migraine frequency, but patients should avoid sudden head movements that might provoke vertigo ¹.
• Limit alcohol and caffeine intake: Both substances can trigger migraines and vertigo symptoms and should be consumed cautiously ¹.
• Hydration and diet: Advise maintaining adequate hydration and a balanced diet, avoiding known dietary triggers such as aged cheeses, processed meats, and artificial sweeteners ¹.
• Safety advice: Patients should be cautioned about activities that may pose risks during vertigo episodes, such as driving or operating machinery, and advised to inform the DVLA if they experience disabling dizziness ¹.

While direct evidence for lifestyle modifications specifically in vestibular migraine is limited, these recommendations align with standard migraine management principles and expert opinion suggesting similar treatment approaches for migrainous vertigo ¹. Recent otolaryngology literature supports these lifestyle strategies as part of a comprehensive management plan for vestibular migraine, emphasizing trigger avoidance and stress management as key components (Brooks et al., 2023).