Vestibular migraine treatment and prevention

INTRODUCTION: Patients with episodic vestibular syndrome (EVS) whose symptoms resemble those of vestibular migraine (VM) but who do not meet the criteria for it are common. OBJECTIVE: To describe those patients suffering from EVS in whom defined etiologies have been ruled out in order to determine if their symptoms can be linked to VM. MATERIAL AND METHODS: Prospective multicenter study. The medical records of patients with VM and patients with EVS suggestive of VM but not meeting the criteria for it were examined. The characteristics of headache, the number and the length of attacks, the association of vestibular symptoms and headache, the intensity of symptoms and the response to treatment were recorded. RESULTS: 58 patients met the criteria for VM or probable VM; 30 did not. All of the symptoms improved significantly in the treated patients with VM or probable VM; in the rest of the treated patients, only the vestibular symptoms improved. CONCLUSION: A subgroup of patients that cannot be attributed to any known vestibulopathy according to present day VM criteria profited from migraine treatment, suggesting that their vestibular symptoms belong to the migraine spectrum; whereas some do not, yet our analysis could not identify distinctive features that allowed subgroup attribution.

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How We Do It: Sphenopalatine Ganglion Blockade for Migraine Treatment

American Journal of Interventional Radiology ◽

10.25259/ajir-34-2018 ◽

2018 ◽

Vol 2 ◽

pp. 14

Author(s):

Allison Forrest ◽

Andrew Cantos ◽

Devang Butani

Keyword(s):

Patient Selection ◽

Migraine Treatment ◽

Sphenopalatine Ganglion ◽

Migraine Disorders ◽

Treatment Procedure ◽

Common Disorder ◽

Safe Option ◽

Treatment And Prevention

Migraine is a common disorder with a range of available abortive and prophylactic treatments. Sphenopalatine ganglion blockade is an effective and safe option for treatment and prevention of migraine disorders. We present an instructional article for sphenopalatine ganglion blockade, including recommended patient selection, treatment procedure, and clinical follow up.

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Acute vestibular migraine treatment with noninvasive vagus nerve stimulation

Neurology ◽

10.1212/wnl.0000000000008388 ◽

2019 ◽

Vol 93 (18) ◽

pp. e1715-e1719 ◽

Cited By ~ 5

Author(s):

Shin C. Beh ◽

Deborah I. Friedman

Keyword(s):

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Retrospective Chart Review ◽

Preliminary Evidence ◽

Vestibular Migraine ◽

Migraine Treatment ◽

Tertiary Referral Center ◽

Headache Severity ◽

Vestibular Symptoms

ObjectiveTo report on the benefits of noninvasive vagus nerve stimulation (nVNS) on acute vestibular migraine (VM) treatment.MethodsThis was a retrospective chart review of patients with VM treated with nVNS in a single tertiary referral center between November 2017 and January 2019. Eighteen patients (16 women) were identified (mean age 45.7 [±14.8] years); 14 were treated for a VM attack and 4 for bothersome interictal dizziness consistent with persistent perceptual postural dizziness (PPPD). Patients graded the severity of vestibular symptoms and headache using an 11-point visual analog scale (VAS; 0 = no symptoms, 10 = worst ever symptoms) before and 15 minutes after nVNS.ResultsIn those with acute VM, vertigo improved in 13/14 (complete resolution in 2, at least 50% improvement in 5). The mean vertigo intensity before nVNS was 5.2 (±1.6; median 6), and 3.1 (±2.2; median 3) following stimulation; mean reduction in vertigo intensity was 46.9% (±31.5; median 45%). Five experienced headache with the VM attack; all reported improvement following nVNS. Mean headache severity was 6 (±1.4; median 6) prior to treatment and 2.4 (±1.5; median 3) following nVNS; mean reduction in headache intensity was 63.3% (±21.7; median 50). All 4 treated with nVNS for interictal PPPD reported no benefit.ConclusionOur study provides preliminary evidence that nVNS may provide rapid relief of vertigo and headache in acute VM, and supports further randomized, sham-controlled studies into nVNS in VM.Classification of evidenceThis study provides Class IV evidence that for patients with acute VM, nVNS rapidly relieves vertigo and headache.

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Vestibular Migraine: Treatment and Prognosis

Seminars in Neurology ◽

10.1055/s-0039-3402067 ◽

2019 ◽

Vol 40 (01) ◽

pp. 083-086

Author(s):

Michael von Brevern ◽

Thomas Lempert

Keyword(s):

Scientific Basis ◽

Vestibular Migraine ◽

Migraine Treatment ◽

Relaxation Techniques ◽

Limited Data ◽

Pharmacological Prophylaxis ◽

Migraine Headaches ◽

Antiemetic Drugs ◽

Acute Attacks ◽

Firm Scientific Basis

AbstractTreatment of vestibular migraine currently lacks a firm scientific basis, as high quality randomized controlled trials are not available. Therefore, recommendations are largely borrowed from the migraine sphere. The first therapeutic step is explanation and reassurance. Many patients do not need pharmacological treatment, as attacks may be infrequent and tolerable. Acute attacks can be ameliorated in some patients with antiemetic drugs such as diphenhydramine, meclizine, and metoclopramide. Frequent attacks may warrant pharmacological prophylaxis with metoprolol, amitriptyline, topiramate, valproic acid, or flunarizine. Nonpharmacological measures including regular exercise, relaxation techniques, stress management, and biofeedback may be similarly effective and can be combined with a pharmacological approach. Limited data indicate that the prognosis appears to be less favorable for vestibular migraine than for migraine headaches.

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Prophylactic Effect of Memantine on Chronic Migraine Headache

Journal of Computational and Theoretical Nanoscience ◽

10.1166/jctn.2019.8606 ◽

2019 ◽

Vol 16 (12) ◽

pp. 5327-5331

Author(s):

Davood Kashipazha ◽

Sahereh Emadi

Keyword(s):

Chronic Migraine ◽

Migraine Headache ◽

Migraine Treatment ◽

Prophylactic Effect ◽

Migraine Headaches ◽

Treatment And Prevention ◽

Significant Difference ◽

High Prevalence ◽

The Mean

Given the high prevalence of migraine treatment failure and resistance to existing drugs and side effects of drugs, finding alternative therapies for refractory patients or chronic migraine is essential. Fifty four patients with migraine headaches were stochastic classified to the 2 groups: placebo and memantine. In first one, memantine is managed at a dose of 20 mg in a day, that enhanced 4 weeks to this dose, and in second group placebo was given. The severity, duration, incapacity, and frequency of migraine headache attacks were recorded at the starting of the research, and the end of first, second, third and fourth months of the study. The mean of VAS score did not have a significant difference at the beginning of the study and at the end of the first month, however here was a significant decrease in the memantine group, during the end of second, third and fourth. After 4 months of behaving, MIDAS score were 22.44±10.62 in the memantine group, when in the placebo group, this was 14.47±1.79 (p <0.0001). The outcomes shows the role of memantine on the treatment and prevention of chronic migraine headaches. In addition, the migraine headaches incidence is mainly decreased in the memantine group in comparison to placebo at the end of the research.

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Failure of Preventive Treatments in Migraine: An Observational Retrospective Study in a Tertiary Headache Center

10.21203/rs.3.rs-25315/v1 ◽

2020 ◽

Author(s):

Marianna Diletta Delussi ◽

Eleonora Vecchio ◽

Silvia Giovanna Quitadamo ◽

Giuseppe Libro ◽

Marina De Tommaso

Keyword(s):

Adverse Events ◽

Preventive Treatment ◽

Primary Outcome Measure ◽

Migraine Treatment ◽

Headache Frequency ◽

Level Of Evidence ◽

Treatment And Prevention ◽

Number Of Patients ◽

Headache Center

Abstract BACKGROUND Despite the criteria of acute migraine treatment and prevention have been well described , there are still unmet needs, for a general underuse and low benefit of preventive treatments. The aim of the present study was to observe retrospectively the short term effect of preventive treatment in a cohort of migraine patients come at a tertiary headache center, using data from an electronic medical record. METHODS This was an observational retrospective cohort study on data collected in a tertiary headache center. Data were extracted from an electronic dataset collected between January 2009 to December 2019. Main selection criteria were age 18-75, diagnosis of migraine without aura(MO), with aura (MA) and chronic migraine (CM), a control visit after three months from the first access, prescription of preventive treatment with level of evidence 1 as reported by Italian guidelines. As primary outcome measure we considered the change of frequency of headache at follow up , as second outcomes disability scores , intensity of headache, allodynia; as predictive factors age, migraine duration, sex and headache frequency, allodynia, anxiety and depression at baseline; comorbidity with fibromyalgia. RESULTS Among 6430 patients screened,2800 met the selection, 1800 returned to follow up, 550 withdrawn for adverse events, 1100 were introduced into analysis. One hundred thirty four had a frequency reduction of 50% or more. Flunarizine was used in less severe migraine, with a better effect as compared to other drugs (odds ratio 1.48; p 0.022). Low headache frequency and absent or mild allodynia predicted a better outcome. CONCLUSIONSThe mild effect of preventive drugs on migraine features and the number of patients lost to follow up or dropped out for adverse events confirm that in severely and chronic sufferers the first line preventive approach could delay a more focused therapeutic approach.

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