Treatment Options for Vestibular Migraine

Abstract

39Population based studies show that primary headaches, such as migraine, are very common disorders. 1 Similar accounts to vertigo and dizziness, which are are also symptoms frequently complained of. 2 A significant proportion of patients report suffering these symptoms (headache, dizziness and/or vertigo) simultaneously and independently of each other. This especially accounts for migraine since up to 50% of these patients report that dizziness or vertigo accompanies their headaches at least once in a while. 3,4 After a first attempt to introduce the term "vestibular migraine" (VM) was made in 1999 5 the International Headache Society (IHS) and the Bárány-Society (International Society for Neuro-Otology) just recently published a consensus paper with diagnostic criteria for VM. 6,7 These criteria were adopted as appendix criteria in the beta version of the third International Classification of Headache Disorders (ICHD-3 beta) to support systematic research on the pathophysiology and treatment of VM. 8 In the clinical setting, these new criteria may serve to aid practitioners in the assessment of patients with VM. While vertigo specialists generally accept the existence of this entity, between headache specialists the discussion is much more controversial. Some people favour this entity, others doubt the existence of the disorder. There is an ongoing debate whether the condition is a unique entity or it simply represents a subtype of common migraine, which also includes vestibular symptoms given that migraines often occurs with predominance of other accompanying symptoms such as excessive vomiting or phonophobia. In contrast there is wide agreement that the pathophysiology of the disorder/symptom complex remains uncertain. 9Recent studies report that approximately two-thirds of patients experiencing vertigo or dizziness seek medical care because of their symptoms, but VM was diagnosed in only 20% of all patients. 10 Interestingly, in routine clinical practice, clinicians reach multiple different interpretations of the symptom complex of headache and vertigo, and these interpretations are often speciality dependent. Neurologists were reported to diagnose VM in 82% of patients with this constellation, while only 64.5% of Ear, Nose, and Throat physicians made this diagnosis. 10 Specific trials particularly addressing the treatment of VM are rare and most treatment guidelines are extrapolated from clinical trials on migraine with and without aura. This review summarizes the available data regarding specific treatment of VM. AbstractAlthough vestibular migraine is a common cause of vertigo, affecting approximately 1% of the Western world's population, it remains widely under-recognized and is under-diagnosed. Diagnostic criteria for vestibular migraine were recently published in collaboration with the International Headache Society and the Bárány-Society. Trials investigating the treatment of vestibular migraine are sparse but some are now underway. This review focuses on the treatments options available for vestibula...

Pharmacotherapy failure and progression to botulinum toxin injection in vestibular migraine

“…Given the paucity of randomised, controlled trials on medications for vestibular migraine, medication management is generally performed according to the physician's discretion and their experience in treating vestibular migraine. 20 Our goal was to elucidate factors associated with pharmacological treatment failure and progression to other types of treatment, namely botulinum toxin injection.…”

“…Although the diagnosis and treatment of vestibular migraine has improved meaningfully over the past decade, there are still many unknowns. 20 Following the 2012 consensus statement by the Bárány Society and International Headache Society, defining vestibular migraine improved dramatically, yet evidence-based treatment guidelines still do not exist. 4,5,20 The majority of vestibular migraine therapy is derived from the literature on migraine treatment.…”

“…20 Following the 2012 consensus statement by the Bárány Society and International Headache Society, defining vestibular migraine improved dramatically, yet evidence-based treatment guidelines still do not exist. 4,5,20 The majority of vestibular migraine therapy is derived from the literature on migraine treatment. Given the paucity of randomised, controlled trials on medications for vestibular migraine, medication management is generally performed according to the physician's discretion and their experience in treating vestibular migraine.…”