The effectiveness of propranolol, flunarizine, amitriptyline and botulinum toxin in vestibular migraine complaints and prophylaxis: a non-randomized controlled study

Results of Treating patients with Chronic Migraine with OnabotulinumtoxinA alone Versus Its Combination with Other Prophylactic Drugs

“…In addition, BTA use along with oral drug therapy significantly improved the Migraine Disability Assessment Scale and seizure frequency compared with oral drug therapy alone. The type of oral medication [propranolol, flunarizine, or amitriptyline] did not differ in terms of frequency of vestibular migraine attacks, increase in DHI score, and increase in MIDAS score [42] .…”

Vestibular migraine treatment: a comprehensive practical review

“…Another study prospectively investigated the same dose of botulinum toxin A (formulation not stated), and 74 patients with VM were recruited, started on oral preventative medication (propranolol 20–80 mg daily, flunarizine 10 mg daily or amitriptyline 25–75 mg daily) and offered botulinum toxin. 69 All patients with VM were considered for inclusion (rather than only those refractory to treatment), and the choice of whether to give botulinum toxin or not was made by the patient. Fourteen patients were excluded due to medication intolerance or failure to attend visits and 60 patients completed the study, of whom 30 received botulinum toxin.…”

“…No serious side effects were seen, with 20% reporting pain at injection sites. 69 Finally, in a retrospective multiple-arm study, five patients with VM and prominent headache (more than 15 headaches per month) who had failed prophylactic medication received botulinum toxin (155 units to 31 sites). 58 In these five patients, mean DHI scores were essentially unchanged from pre- to post-treatment (mean reduction of 3.6 points).…”

“… 91–94 The evidence for botulinum toxin to treat vestibular symptoms is currently very limited and somewhat conflicting, thus currently best suited to VM patients with prominent headache, as from the current evidence it appears to be less effective for vestibular symptoms. 69 Additionally, it is expensive and may not be widely available: in the UK, botulinum toxin is funded for chronic migraine after failure of at least three other preventative treatments; however, it is not funded for VM. A single-centre analysis of CGRP inhibitors (not included in this review due to not meeting inclusion criteria) found that 60% of patients with VM retrospectively reported improvement in vestibular symptoms.…”

Vestibular migraine: epidemiology, pathogenesis, clinical picture, diagnosis and treatment

“…Профилактическое лечение показано при высокой частоте и/или тяжести приступов. Имеется некоторая доказательная база, подтверждающая эффективность при ВМ ингибиторов карбоангидразы, противоэпилептических препаратов, антидепрессантов, блокаторов кальциевых каналов, бета-блокаторов и ботулотоксина типа А [65][66][67][68][69][70]. Появляются данные, указывающие на эффективность в лечении ВМ препаратов, блокирующих рецепторы кальцитонин-ген-родственного пептида (CGRP) [71].…”