A preliminary trial of botulinum toxin type A in patients with vestibular migraine: A longitudinal fMRI study

Abstract

ObjectiveThis study aims to investigate the efficacy of botulinum toxin type A (BTX-A) in the prophylactic management of vestibular migraine (VM) and to determine whether this treatment modulates intrinsic functional brain network.MethodsVestibular migraine patients (n = 20, mean age 45.4 years) who were resistant to conventional prophylactic therapies had BTX-A injection and rs-fMRI before and 2 months after the injection. We also measured the changes in the frequency of vertigo and migraine attacks, symptomatic functional disability scores, and neuropsychiatric inventories.ResultsAfter BTX-A injection, the mean monthly frequencies of migraine and vertigo episodes decreased significantly compared with the baseline (p < 0.01, paired t-test). The Headache Impact Test-6 score and the Migraine Disability Assessment, and the vertigo parameters, measured by the Dizziness Handicap Inventory and the Vertigo Symptom Scale, showed an improvement, as did the anxiety and depression scores 2 months after BTX-A treatment. The low-frequency fluctuation analysis of the rs-fMRI data found significant changes in the functional connectivity of the right superior temporal gyrus. Adoption of this cluster as the seed region increased the functional connectivity with the left post-central gyrus, right supramarginal gyrus, and right middle temporal gyrus after BTX-A treatment.ConclusionThis prospective study suggests that BTX-A treatment is effective at ameliorating migraine and vertigo symptoms in VM patients who were resistant to conventional therapies. Along with symptomatic improvements, changes in the functional connectivity within the multisensory vestibular and pain networks suggest a dysmodulation of multimodal sensory integration and abnormal cortical processing of the vestibular and pain signals in VM patients.

Optimal Design of Galvanic Vestibular Stimulation for Patients with Vestibulopathy and Cerebellar Disorders

“…Oh) and vestibular function tests including a video head impulse test (vHIT), bithermal caloric test and ocular and cervical vestibular evoked myogenic potentials (cVEMP and oVEMP). Vestibular function tests were described in previous reports [ 33 , 34 ]. Nine patients with acute or chronic UVP and nine BVP patients, including patients with idiopathic bilateral vestibulopathy (n = 2), presbyvestibulopathy (n = 3) and CANVAS (cerebellar ataxia, neuropathy and vestibular areflexia syndrome, n = 4), were recruited.…”

Vestibular Migraine

“…Anti-CGRP medications (monoclonal antibodies and gepants) have demonstrated moderate to significant VM improvement in 60% (n = 15) of patients [83]. Onabotulinumtoxin A injections have been shown to be effective in reducing vertigo and headaches in resistant VM cases, as reflected by improvements in the Headache Impact Test, Migraine Disability Assessment, Dizziness Handicap Inventory, Vertigo Symptom Scale, and even changes in functional brain connectivity [84].…”

Vestibular Migraine Therapy: Update and Recent Literature Review

“…An overall reduction in the mean monthly frequency of headache and vertigo after two months after treatment was observed: the baseline mean monthly frequency of 17 migraine headaches and 14 vertigo episodes reduced to the mean monthly frequency of 9.5 (p = 0.001) and 8.5 (p < 0.001), respectively. Also, a significant reduction in Head Impact Test (HIT-6), Migraine Disability Assessment Test (MIDAS), Migraine-Specific Quality-of-Life Questionnaire (MSQ), Vertigo Severity Score (VSS), Dizziness Handicap Inventory (DHI), Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) scores was observed [13]. The small sample size and the study design make the evidence of low certainty.…”