番茄社区

Noninvasive vagus nerve stimulation (nVNS) relieved vertigo and headache in acute vestibular migraine, an open-label preliminary study suggested.

Vertigo improved in 13 of 14 acute vestibular migraine patients, and all five patients who had a headache with their vestibular migraine attack said their head pain had improved, reported Shin Beh, MD, and Deborah Friedman, MD, MPH, both of the University of Texas Southwestern Medical Center in Dallas, in .

"Vestibular migraine is the most common neurological cause of vertigo in adults, but there are no FDA-approved treatments for it," Beh told 番茄社区. "To our knowledge, this is the first study to describe the benefits of nVNS in vestibular migraine."

"Our study highlights the close pathophysiologic relationship between migraine headache and vestibular migraine and supports the migrainous etiology of vestibular symptoms in this disorder," Beh continued. "It suggests that the vagal circuitry is interconnected with the vestibular system, and these connections may explain how nVNS alleviates vertigo in vestibular migraine attacks."

Vertigo and headaches have an inconsistent relationship in vestibular migraine: head pain may accompany attacks, but often is less severe than typical migraine headaches. While vestibular suppressants and antiemetics are used to treat acute attacks, they can cause sedation. Triptans sometimes are prescribed, but the .

"Vestibular migraine is a migraine subset that can be very disabling and for which we lack effective treatments," noted Rashmi Halker Singh, MD, of the Mayo Clinic in Phoenix, who was not involved with the study.

"The idea that these authors found noninvasive neuromodulation to be helpful is extremely exciting, especially since the nVNS device is easy to use and without significant side effects for most patients," she told 番茄社区.

Beh and Friedman conducted a retrospective chart review of vestibular migraine patients treated with nVNS at a single tertiary referral center from November 2017 to January 2019. They looked at 18 patients, 14 who were treated for an acute vestibular migraine attack and four for interictal dizziness consistent with persistent perceptual postural dizziness (PPPD).

No patient had a history of other conditions that could cause vertigo and none had taken any migraine abortives, antiemetics, or vestibular suppressants within a 24-hour period, although some patients were on migraine prevention drugs. Mean patient age was about 46 and 89% were women.

Patients received gammaCore nVNS (which is approved for episodic cluster headache and migraine) as a possible rescue therapy. This involved noninvasive stimulation through a handheld device placed against the neck that delivered electrical impulses to the vagus nerve for 2 minutes on each side of the neck. Patients graded the severity of their vestibular symptoms and headache on an 11-point visual analog scale (in which 0 represented no symptoms and 10 represented worst-ever symptoms) both before and 15 minutes after nVNS.

Thirteen of 14 patients reported that vertigo improved after nVNS: two patients reported complete resolution and five said they had at least 50% improvement. Mean vertigo intensity was 5.2 before stimulation and 3.1 after treatment; the mean reduction in vertigo intensity was 46.9%.

Only five patients experienced headache with their vestibular migraine attack and all reported improvement after nVNS. One patient experienced complete resolution, and four reported at least 50% improvement in the intensity of their headache. Mean headache severity was 6 before treatment and 2.4 after nVNS, and the mean reduction in headache intensity was 63.3%.

All four patients treated with nVNS for interictal PPPD reported no benefit.

Patients reported feeling a mild pulling sensation of neck musculature during stimulation, but no pain or adverse effects (like or ) described in other nVNS studies.

"The anatomical and physiologic evidence of extensive vestibulo-vagal interaction provide the underpinnings that may explain how nVNS ameliorates vestibular migraine attacks," Beh and Friedman observed. "A sham-controlled, randomized clinical trial is needed to further elucidate the benefits of nVNS in treating vestibular migraine."

This study was preliminary and has several limitations, they added. Its sample size was small, its design was open-label, and placebo effects may have occurred. Timing of nVNS treatment was not uniform, and the nature of the study made it difficult to determine whether improvements persisted.

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