Herbal Remedies and Supplements
The world of herbal remedies for vestibular disorders is vast and largely unregulated, with hundreds of products claiming to treat dizziness, vertigo, and balance problems. While some herbs have traditional uses and preliminary research supporting their potential benefits, the majority lack high-quality scientific evidence for treating vestibular disorders specifically. Understanding the limited evidence available, potential risks, and quality issues with herbal supplements helps people make informed decisions about these approaches.
Ginkgo biloba is one of the most commonly recommended herbs for dizziness and balance problems, based on its theoretical ability to improve blood circulation to the brain and inner ear. Some studies have suggested that ginkgo might help with certain types of dizziness, particularly in older adults or those with circulatory problems. However, the evidence is mixed, with some studies showing modest benefits and others showing no effect. The standardized extract EGb 761 has the most research support, typically used in doses of 120-240mg daily. Safety concerns include potential bleeding risk, especially when combined with blood-thinning medications, and possible interactions with other drugs.
Butterbur (Petasites hybridus) has some evidence for migraine prevention, which may make it relevant for people with vestibular migraine. Several randomized controlled trials have shown that standardized butterbur extracts can reduce migraine frequency and severity. However, raw butterbur contains potentially toxic compounds called pyrrolizidine alkaloids, so only products certified as PA-free should be used. The evidence for butterbur specifically treating vestibular symptoms (as opposed to migraine headaches) is limited, and liver toxicity has been reported with some butterbur products.
Feverfew (Tanacetum parthenium) is another herb traditionally used for migraines that may have relevance for vestibular migraine. Some studies suggest feverfew can help prevent migraines, though results have been inconsistent and the overall evidence is weaker than for butterbur. The active compound parthenolide varies significantly between products, and standardization is often poor. Side effects can include mouth ulcers, digestive upset, and rebound headaches when discontinued abruptly.
Traditional Chinese Medicine (TCM) formulas are sometimes recommended for vestibular disorders, with several herbal combinations having been studied for dizziness and vertigo. Banxia Baizhu Tianma Tang is one formula that has shown some promise in preliminary studies for certain types of dizziness. However, TCM formulas are complex mixtures of multiple herbs, making it difficult to identify active compounds or standardize treatments. Quality control can be problematic, and some imported TCM products have been found to contain undeclared pharmaceuticals or toxic contaminants.
Magnesium supplementation is sometimes recommended for vestibular migraine based on evidence that magnesium deficiency may contribute to migraines and that magnesium supplementation can help prevent migraines in some people. The evidence for magnesium specifically treating vestibular symptoms is limited, but given that magnesium deficiency is relatively common and supplementation is generally safe, it may be worth considering for people with vestibular migraine, particularly those with documented deficiency or other risk factors.
Coenzyme Q10 (CoQ10) has some evidence for migraine prevention and is sometimes recommended for vestibular migraine. Several studies have shown that CoQ10 supplementation can reduce migraine frequency and severity, though the evidence is not as strong as for some other preventive treatments. CoQ10 is generally well-tolerated but can be expensive and may interact with certain medications, particularly blood thinners.
Quality and safety issues plague the herbal supplement industry, with studies consistently finding problems with purity, potency, and contamination. Products may contain less of the active ingredient than claimed, may be contaminated with heavy metals or other toxins, or may contain undeclared pharmaceuticals. Third-party testing by organizations like USP, NSF, or ConsumerLab can help identify products that meet quality standards, but such testing is voluntary and not universal.