Vestibular migraine treatment vertigo
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Vestibular Migraine Treatment for Vertigo
Vestibular migraine (VM) is a neurological condition characterized by recurrent episodes of vertigo, often accompanied by migraine symptoms such as headache, photophobia, and phonophobia. This condition significantly impacts the quality of life of affected individuals. Here, we synthesize the current research on pharmacological treatments for both the prophylaxis and acute management of vestibular migraine-related vertigo.
Prophylactic Treatments for Vestibular Migraine
Beta-Blockers and Calcium Channel Blockers
Beta-blockers, such as metoprolol, and calcium channel blockers, such as flunarizine, have been evaluated for their efficacy in preventing vestibular migraine attacks. A study on metoprolol showed no significant difference in the incidence of vertiginous attacks compared to placebo, although both groups experienced a decline in vertigo frequency over time1 4. Similarly, flunarizine was found to be effective in reducing vertigo frequency and improving dizziness handicap inventory (DHI) scores, but it had poor tolerability5.
Antiepileptics and Antidepressants
Antiepileptic drugs like valproate acid (VPA) have shown promise in reducing vertigo frequency and improving DHI scores, although they also come with significant side effects5. Antidepressants, including tricyclics and serotonin-noradrenaline reuptake inhibitors, have been used with some success, particularly in patients with comorbid anxiety6.
Monoclonal Antibodies Against CGRP
Recent studies have explored the use of monoclonal antibodies against calcitonin gene-related peptide (CGRP) for VM. These treatments, including erenumab, fremanezumab, and galcanezumab, have shown significant efficacy in reducing both vertigo and headache frequency, with a substantial number of patients experiencing at least a 50% reduction in symptoms10.
Acute Management of Vestibular Migraine Attacks
Triptans
Triptans, commonly used for acute migraine attacks, have been evaluated for their effectiveness in treating acute vestibular migraine. Studies on rizatriptan and zolmitriptan indicated that these medications might not significantly improve vertigo symptoms within two hours of administration, and the evidence remains very uncertain2.
Other Pharmacological Interventions
Other medications, such as ergot alkaloids, dopamine antagonists, antihistamines, and NSAIDs, have been proposed for acute VM management, but there is a lack of robust placebo-controlled trials to support their efficacy2.
Non-Pharmacological Approaches
Non-pharmacological strategies, including dietary changes, sleep hygiene, and avoidance of known migraine triggers, are recommended as part of a comprehensive management plan for VM. Vestibular rehabilitation may also be beneficial for patients experiencing balance issues or visual dependence6 8.
Conclusion
The treatment of vestibular migraine, particularly for vertigo, remains challenging due to the limited high-quality evidence available. Beta-blockers, calcium channel blockers, antiepileptics, and monoclonal antibodies against CGRP show potential for prophylactic use, while triptans and other acute treatments require further investigation. Non-pharmacological measures and lifestyle modifications are essential components of a holistic treatment approach. Further research is needed to establish more definitive treatment guidelines and improve patient outcomes.
Sources and full results
Most relevant research papers on this topic
Pharmacological interventions for prophylaxis of vestibular migraine
Beta-blockers show limited evidence for reducing the frequency of vestibular migraine attacks, while calcium channel blockers show no evidence for this purpose.
Meta-Analysis
Very Rigorous JournalPharmacological interventions for acute attacks of vestibular migraine
Triptans may help reduce the severity of symptoms in acute attacks of vestibular migraine, but their long-term safety and effectiveness remain unclear.
Meta-AnalysisVery Rigorous JournalVestibular migraine: a critical review of treatment trials
Vestibular migraine patients can benefit from zolmitriptan for abortive treatment and similar prophylactic and abortive strategies as those used for migraine in adults.
Systematic Review
Highly CitedResults and lessons learnt from a randomized controlled trial: prophylactic treatment of vestibular migraine with metoprolol (PROVEMIG)
Metoprolol succinate showed no significant difference in the prevention of episodic vertigo- and migraine-related symptoms in patients with vestibular migraine compared to placebo.
RCTVery Rigorous JournalProphylactic treatments for vestibular migraine: a systematic review and network meta-analysis of randomized clinical trials
Valproate acid and flunarizine effectively reduced vertigo frequency and improved dizziness handicap index, but had unfavorable tolerability.
Meta-AnalysisManagement of vestibular migraine
Vestibular migraine is managed with prophylactic medication, and nonpharmacological measures, such as diet, sleep, hygiene, and avoidance of triggers, are also recommended.
Highly CitedVestibular migraine treatment: a comprehensive practical review
Vestibular migraine treatment has a low quality evidence base, but this review provides practical treatment recommendations based on available evidence and experience to guide clinicians treating patients.
Systematic ReviewMedical Management of Migraine‐Related Dizziness and Vertigo
Individualized treatment approaches, including dietary changes, medication, physical therapy, lifestyle adaptations, and acupuncture, effectively control migraine-related vestibular symptoms.
Highly CitedVestibular Migraine
Vestibular migraine is a condition characterized by attacks of vertigo lasting 5 minutes to 3 days, with a diagnosis based on symptom type, severity, duration, history of migraine, and exclusion of other causes.
Highly CitedAnti-calcitonin gene-related peptide monoclonal antibodies for the treatment of vestibular migraine: A prospective observational cohort study
Anti-CGRP mAbs may effectively treat vestibular migraine, reducing symptom frequency and improving quality of life.
Observational Study