In my case, topiramate has helped a lot. It may be that I wouldn’t have had any more of the severe dizzy spells anyway, now that I’ve had my last period (at least I’m pretty sure I have…). I could tell I was having at least one doozy of a spike in estrogen back during my perimenopausal days because I had to postpone a mammogram for the first time in my life - I was so swollen I thought I was ready to start nursing a baby (in my early 50’s!), and I figured it would hurt like crazy. It was shortly after that that I had my first episode of severe dizziness, complete with tunnel vision (I now know that was an aura, not just a sign that I was so dizzy I was about to pass out, which is what I thought was going on at the time). That was the first of 3 such episodes.
But what eventually came to pass was a lingering daily wobbliness, including what I believe is referred to as “head motion intolerance” (I would move my head and stop it, but it would feel like it was still moving). I didn’t know when the next severe episode might strike, plus I wanted to get rid of the daily dizziness (mostly mild, but sometimes moderate), and I believe it was topiramate that has done that for me.
Prior to this, I didn’t realize I was a migraineur because I thought I’d been having sinus headaches throughout my life. I have never really had horrible headaches, so that aspect of migraine hasn’t been a big, disabling issue for me. But when the perimenopausal rollercoaster ride started, my migraine brain really reacted. I’m just sorry that my poor mother never knew what hit her. I was away at college when her dizziness started and we were at odds at that time in our lives (politics, unfortunately, got in the way - not in later years, thank goodness) so I wasn’t really aware of it. My younger brother told me she used to have to crawl to the bathroom from her bedroom sometimes because she was so dizzy.
Yes, hormones can be a significant migraine trigger, and the menopause transition can be really rough on some of us even without dizziness - but throw that in there too, and it’s pretty crappy that so many of us can’t get help for it, as well as so many of the other troubling symptoms.