Factors determining the response to treatment in patients with vestibular migraine

ABSTRACT

Purpose

To find out clinical features associated with poor response to treatment in vestibular migraine (VM)

Methods

VM patients treated with drugs recommended in migraine prophylaxis were included in this multicenter study. Migraine features including type, age of onset of headache and vertigo attacks, attack frequency, intensity, associated symptoms, triggering factors, presence of interictal dizziness/imbalance, anxiety, depression, history of motion sickness, and family history of migraine were noted. Amitriptyline, flunarizine, propranolol, topiramate and venlafaxine were chosen depending on patients’ individual requirements. Maximum dose of each drug was tried for 2 months to decide its efficacy. In the case of inefficacy, it was changed with another preventive drug of different class. If there was still no improvement, two drugs of different classes were combined. ≥ 50% reduction in attack frequency and severity in patients using one drug and a combination of two drugs was compared, with patients showing <50% reduction despite combination therapy, regarding their clinical features.

Results

The results of 430 VM patients, 65 men and 365 women with a mean age of 42.2 ± 12.2 years (range: 17–74 years), were analyzed.    

Conclusion

Cutaneous allodynia frequently associated with female sex, comorbid anxiety and depression and interictal dizziness/imbalance enhanced with comorbid anxiety were risk factors for reduced treatment response. Aural fullness might be the clue of impending concomitant Meniere’s disease not responding to migraine preventives.

KEYWORDS:

• Vestibular migraine
• treatment
• allodynia
• dizziness/imbalance
• anxiety/depression

Abbreviations

BPPV: Benign paroxysmal positional vertigo

CI: Confidence Interval

ICHD: International Classification of Headache Disorders

MD: Meniere’s Disease

MwA: Migraine with aura

MwoA: Migraine without aura

OR: Odds Ratio

VM: Vestibular migraine

VAS: Visual analog scales

Acknowledgment

The authors would like to thank Atilla Atasever for his contribution for the statistical analysis.

Authors’ contributions

Study protocol and design: NC, AKA, FG

Acquisition of data: NC, AKA, HNO, DTK, HET, VY, AICI, IE, PO, GA, CA, SB, EOG, FGU

Analysis and interpretation of data: NC, AKA, FG, GA

Drafting of the manuscript: NC, AKA

All the authors read and approved the final manuscript.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

Ethics approval and consent to participate

The study protocol was approved by the Ege University Medical School Ethics Committee (reference number: 99,166,796-050.06.04), and approval from the local ethics committees of all the participating centers was gathered.

Consent for publication

A written informed consent was obtained from each patient for the publication of this report.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.