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Background and Aims Studies have demonstrated evidence for the therapeutic role of intravenous (IV) magnesium (Mg) in migraine. Whilst a portion of these patients have dizziness, IV Mg has never been used specifically for pure vestibular migraine. We explored the efficacy of IV Mg in a subset of dizzy acute migraine patients in the neurology same day emergency care service at University College Hospital, London.Methods A retrospective observational study of patients with acute migraine including specifically dizziness was carried out. Patients were given treatment with 1g IV Mg following review by consultant neurologists. Outcomes were assessed through patient self-reported benefit at follow up in clinic or telephone interview.Results 44 suitable patients were identified. All patients presented with migraine and reported acute dizziness. 39 were female, with a mean age of 43 (SD 12.8 years). A beneficial effect was noted in 19 patients, no improvement in 8 and missing data in 17. There was no worsening of symptoms or serious adverse side effects.Conclusion This study provides preliminary support for the use of IV Mg in acute migraine with dizziness and encourages future studies of IV Mg for vestibular migraine. An assessment protocol for such a study is provided.kimberley.kee@nhs.net