Lamotrigine with Anti-Anxiety Medication may be an Effective Treatment for Patients with Vestibular Migraine: A Retrospective Study

Abstract

Vestibular migraine (VM) is a condition characterized by prolonged vertigo, typically lasting minutes to days, with or without headaches. VM has a high comorbidity with anxiety and other mood disorders. Persistent postural-perceptual dizziness (PPPD) is chronic non-spinning vertigo, lasting seconds to minutes, which also has a high comorbidity with anxiety and mood disorders. Lamotrigine, a sodium channel blocker may be an effective prophylactic for VM, and anti-anxiety medication may be effective in reducing lingering vertigo symptoms in VM patients by eliminating symptoms of PPPD. Researchers conducted a retrospective chart review of 95 patients diagnosed with VM and prescribed lamotrigine to explore lamotrigine’s effect on VM symptoms. Of the 95 patients examined, 68 patients continued lamotrigine and had at least one follow-up visit. 64 of the 68 patients (94%) taking lamotrigine reported significant improvement in their vertigo and migraine attacks from prior to treatment, while 4 (6%) reported no improvement. 67 patients (71%) of the 95 initially reviewed had comorbid anxiety/mood disorders. Of the 68 patients consistently taking lamotrigine, 43 (67%) of patients were also on anti-anxiety medication. Lamotrigine may be an effective prophylactic to reduce the number and severity of VM episodes. Furthermore, lamotrigine in conjunction with anti-anxiety medication may further reduce PPPD symptoms in patients and overall improve patient’s quality of life. We propose a “Dizziness threshold theory” to explain this phenomenon. Patients with PPPD are hypersensitive to positional changes and visual stimulation; this suggests they have a lowered “dizziness threshold,” the threshold neuronal activity has to meet trigger symptoms of dizziness. For patients with VM, we propose that while their “dizziness threshold” may remain normal, they have periods of neuronal hyperactivity which triggers episodes of vertigo.

[N A J Med Sci. 2026;19(1):019-025.   DOI: 10.7156/najms.2026.1901019]

Key Words: Vestibular migraine, migraine-associated vertigo, persistent postural-perceptual dizziness,

cortical spreading depression, retrospective study, Lamictal, vestibular disorders