Is prophylactic treatment appropriate for vestibular migraine?

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Is prophylactic treatment appropriate for vestibular migraine?

Vestibular migraine (VM) has been known as a common cause of episodic vertigo. The management of VM inculcates two conditions: the vestibular symptom attacks and the period between strikes. Some prophylaxis methods can be used for the later. Presently, the recommendation is to use the same prophylactic drugs used for migraines, plus β-blockers, antidepressants and anticonvulsants. Present-day definition of vestibular migraine makes the number of studies on its treatment limited.

The aim of the research is to estimate the efficacy of prophylactic treatment used in patients from a VM outpatient.

The diagnostic measure employed for vestibular migraine used were the criteria initiated in 2012 by the Bárány Society and the International Headache Society (IHD) inculcated in the third version of the International Classification of Headache Disorders – ICHD. Drugs used in the treatment and treatment response attained via the visual analog scale (VAS) for dizziness and headache were analyzed. Comparison of the pre- and post-treatment VAS scores were made (the improvement was evaluated together and individually, per drug used).

Out of total 88 assessed records, 47 were eligible. The patients that met the diagnostic criteria for VM were considered. Patients whose medical records were illegible and those of patients with other disorders produced dizziness and/or headache that did not meet the 2012 criteria for VM were not considered. Advancement with prophylaxis (p < 0.001) was observed in 80.9% patients. Flunarizine, Topiramate, Propranolol and Amitriptyline improved vestibular symptoms (p < 0.001) and headache (p < 0.015) and were effective in a statistically significant way. The time of vestibular symptoms and clinical improvement depicted positive statistical association between them. No additional benefit in hypertensive patients who used antihypertensive drugs as prophylaxis or depressed patients who took antidepressants in relation to other prophylactic drugs was noticed. Drug association did not show statistically significant results with regard to the use of a single drug.

Thus, it was concluded that prophylactic medications used to manage VM improve the symptoms of this disease, but there is no statistically significant difference between the responses of prophylactic drugs. With the prophylactic treatment, the time of vestibular symptom seems to increase its benefit.

Braz J Otorhinolaryngol.
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