Management of mal de debarquement syndrome as vestibular migraines

Laryngoscope. 2017 Jul;127(7):1670-1675. doi: 10.1002/lary.26299. Epub 2016 Oct 12.


Objective: Mal de debarquement syndrome (MdDS) is a balance disorder that typically starts after an extended exposure to passive motion, such as a boat or plane ride. Management is typically supportive (e.g. physical therapy), and symptoms that persist beyond 6 months have been described as unlikely to remit. This study was conducted to evaluate the response of patients with MdDS to management with migraine prophylaxis, including lifestyle changes and medical therapy.

Study design: Prospective review.

Setting: Ambulatory setting at a tertiary care medical center.

Methods: Clinical history, detailed questionnaires, and audiograms were used to diagnose patients with MdDS. Those patients with the diagnosis of the MdDS were placed on our institutional vestibular migraine management protocol. Treatment response was assessed with a quality-of-life (QOL) survey and visual analog scale.

Results: Fifteen patients were diagnosed with MdDS, with a predominance of females (73%) and a mean age of 50 ± 13 years. Eleven patients (73%) responded well to management with a vestibular migraine protocol, which included lifestyle changes, as well as pharmacotherapy with verapamil, nortriptyline, topiramate, or a combination thereof. In comparison, a retrospective control group of 17 patients demonstrated a lower rate of improvement when treated with vestibular rehabilitation and physical therapy.

Conclusion: Management of MdDS as vestibular migraine can improve patients' symptoms and increase the QOL. Nearly all the patients suffering from MdDS had a personal or family history of migraine headaches or had signs or symptoms suggestive of atypical migraine.

Level of evidence: 4 Laryngoscope, 127:1670-1675, 2017.

Keywords: MdDS; mal de debarquement syndrome; quality of life; vestibular migraine.

MeSH terms

  • Adult
  • Aged
  • Drug Therapy, Combination
  • Female
  • Fructose / analogs & derivatives*
  • Fructose / therapeutic use
  • Genetic Predisposition to Disease / genetics
  • Humans
  • Male
  • Meniere Disease / diagnosis
  • Meniere Disease / drug therapy*
  • Meniere Disease / genetics
  • Middle Aged
  • Migraine Disorders / diagnosis
  • Migraine Disorders / drug therapy*
  • Migraine Disorders / genetics
  • Motion Sickness / diagnosis
  • Motion Sickness / drug therapy*
  • Motion Sickness / genetics
  • Nortriptyline / therapeutic use*
  • Prospective Studies
  • Quality of Life
  • Topiramate
  • Travel
  • Travel-Related Illness
  • Verapamil / therapeutic use*
  • Visual Analog Scale


  • Topiramate
  • Fructose
  • Nortriptyline
  • Verapamil

Supplementary concepts

  • Mal de debarquement