“Vestibular migraine”: effects of prophylactic therapy with various drugs

Abstract

Vertigo is frequently associated with migraine, and sometimes it is the cardinal symptom. This type of migraine is called "vestibular migraine", "migrainous vertigo", or "migraine-associated vertigo". Earlier findings on effective prophylactic medication for such migraine attacks and their clinical features are few and insufficient. Our aim was to study the influence of prophylactic therapy on this type of migraine and to specify its clinical features. In a retrospective approach 100 patients (median age 47 years, range 21-72 years) with definite or probable vestibular migraine were divided into two groups: those with (74 patients) and those without drug prophylaxis (26 patients). They were then interviewed by telephone at least 6 months after beginning therapy. All patients receiving medical prophylaxis showed a decrease of duration, intensity, and frequency of episodic vertigo as well as nearly all its associated features (p < 0.01). The group without medical prophylactic therapy showed only a reduction of vertigo intensity. Only 39 % of the 100 patients met the current IHS criteria for a basilar-type migraine. Thus, we propose that a new category--"vestibular migraine"--should be added to the HIS criteria. Furthermore, our data show that prophylactic medication may be effective for treating vestibular migraine and its associated symptoms; therefore, patient's response to medical therapy may provide guidance in the diagnostic process of vestibular migraine.

Vestibular migraine: diagnosis challenges and need for targeted treatment

“…Medications used were beta-blocker, 49 patients, metoprolol (median dose 150 mg) or propranolol (median dose 160 mg), valproic acid, 6 patients (median dose 600 mg), topiramate, 6 patients (median dose 50 mg), butterbur extract, 4 patients (median dose 50 mg), lamotrigine, 3 patients (median dose 75 mg), amitriptyline 2 patients (75 to 100 mg), flunarizine, 1 patient (5 mg), and magnesium 3 patients (median dose 400 mg). The group without prophylactic therapy showed a reduction of vertigo intensity only 54 . An ongoing trial will test the efficacy of metoprolol in vestibular migraine (Prophylactic treatment of vestibular migraine with metoprolol -PROVEMIG trial) 55 .…”

Headache and Sadness: Two Independent Symptoms or Different Spectros of the Same Disease

“…Gurkov et al [7] says that Neuhauser et al [13] diagnostic criteria present a broad base as a starting point to help clinicians guide themselves. Neuhauser & Lempert [1] report that the pathophysiology of MV is still unclear, none of the possible pathophysiological mechanisms for MV have been investigated experimentally.…”

“…Baier et al [13] performed myogenic evoked potential (VEMP's) in patients with defined MV and in patients with probable MV. It was concluded that patients with vestibular migraine have low amplitudes on both sides (left and right) when compared to healthy patients.…”

“…In the study by Baier et al [13], it was concluded that conservative therapy and lifestyle adaptations can contribute to the reduction of dizzying seizures in about 1/3 of the patients. Therefore, the response to prophylactic therapy as a diagnostic criterion for MV cannot be absolute.…”

Diagnostik und Therapie vestibulärer Störungen

“…Randomisierte kontrollierte Studien zur Wirksamkeit von Medikamenten bei der vestibulären Migräne liegen allerdings bislang nicht vor. In einer retrospektiven Studie konnte der günstige Effekt der medikamentösen Prophylaxe nachgewiesen werden [20]. In prospektiven Studien über die Dauer von 1 Jahr fällt eine hohe Komorbidität mit Angsterkrankungen und Depressionen auf, was bei der Therapie berücksichtigt werden sollte [21,22].…”