Clinical characteristics and treatment choice in vestibular migraine. (June 2018)

• Record Type: Journal Article
• Authors: Power, L.; Shute, W.; McOwan, B.; Murray, K.; Szmulewicz, D.
• Is Part Of: Journal of clinical neuroscience. Volume 52(2018)
• Page Start: 50
• Page End: 53
• Publication Date: 2018-06
• Subjects: Vestibular -- Migraine -- Headache -- Vertigo; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.02.020
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Vertigo (96%) and headache (60%) were the predominate symptoms. Headache not a necessary symptom of vestibular migraine. 86% of patients had a normal exam. Six (5%) had a positive vHIT and seven (6%) had oculomotor abnormalities. Pizotifen (30%) and amitriptyline (21%) were the two most commonly used medications. On average 1.4 different medications were required to obtain symptom control. Only 16% were referred for physiotherapy, despite 56% reporting motion-induced symptoms. Physiotherapy is underutilised. Abstract: This retrospective review aims to survey the clinical characteristics and management of vestibular migraine (VM) patients seen in a tertiary hospital multi-disciplinary balance disorders clinic, and how this aligns with the evidence base in the literature. A single investigator reviewed the medical records of the patients who presented to a tertiary hospital balance disorders clinic over a four month period and identified 90 cases of VM. The mean age of patients with a diagnosis of VM was 50 years (range of 17–84) and 72 (80%) were female. Vertigo (96%) and headache (60%) were the predominate symptoms. Vestibular function testing abnormalities included six (5%) with a positive video head impulse test and seven (6%) with oculomotor abnormalities. Pizotifen (30%) and amitriptyline (21%) were the two most commonly used medications whilst only 14 (16%) received vestibular physiotherapy. This study suggests that VM is a very common presentation to a tertiary balance disorders clinic, but there is little consensus in choice of initial management and vestibular rehabilitation is underutilized. This data may be valuable in informing the practice of neuro-otology as well as in the planning of future service provision.