Important new studies on MAV – Journal of Neurology

Hi All,

Two new important papers turned up in this month’s Journal of Neurology. I think it won’t be long before we see “vestibular migraine” finally officially recognised and added to the International Headache Society (IHS) list of what can constitute migraine.

The first paper:

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[size=130]“Vestibular migraine”: effects of prophylactic therapy with various drugs : A retrospective study.[/size]
Baier B, Winkenwerder E, Dieterich M
Journal of Neurology, Mar 2009

Our aim was to study the influence of prophylactic therapy on this type of migraine and to specify its clinical features. In a retrospective approach 100 patients (median age 47 years, range 21-72 years) with definite or probable vestibular migraine were divided into two groups: those with (74 patients) and those without drug prophylaxis (26 patients). They were then interviewed by telephone at least 6 months after beginning therapy. All patients receiving medical prophylaxis showed a decrease of duration, intensity, and frequency of episodic vertigo as well as nearly all its associated features (p < 0.01). The group without medical prophylactic therapy showed only a reduction of vertigo intensity. Only 39% of the 100 patients met the current IHS criteria for a basilartype migraine. Thus, we propose that a new category - “vestibular migraine” - should be added to the IHS criteria.

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Take home message: migraine meds work for MAV for significantly reducing duration, intensity, and frequency of attacks and symptoms whereas “conservative” and “moderate” therapies such as lifestyle changes, hormones, trigger avoidance and benzos only reduced intensity. Propranolol was the most frequently used drug in this study. It does appear that using one drug only for MAV (monotherapy) gives marginal results which probably explains why so many need two or even three drugs to knock this thing out.

The second paper:

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[size=130]Vestibular migraine: a critical review of treatment trials.[/size]
Fotuhi M, Glaun B, Quan SY, Sofare T
Journal of Neurology, Mar 2009

We performed a comprehensive literature search regarding treatment for VM or migraine-associated vertigo during the period of 1990-2008 and used, individually or in combination, the search terms VM, migraine-associated vertigo, migraine-associated dizziness, migrainous vertigo, migraine and vertigo, migraine and disequilibrium, and headache and vertigo. We found nine publications that address treatment strategies for VM. One small randomized clinical trial found some benefit from the use of zolmitriptan for abortive treatment of VM. The other eight observational studies showed marginal improvement with migraine prophylactic medications such as nortriptyline, verapamil, or metoprolol. Until more specific treatment options become available, patients with VM need to be managed with similar prophylactic and abortive strategies as those used for migraine in adults.

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Best … Scott 8)

Glad to see this, Scott. I hope MAV will soon be given the attention it deserves and hope somehow the message will get to my doctors that this is a real disease!
Thanks, BW

Hey bookworm,

It’s got to happen soon. These two papers can at least be printed off and taken to someone’s doctor – especially the ones who are not on the ball.

Joe, I was thinking you could do exactly that (print them) next time you have to see that neurologist again. Just dump these on his lap and he’ll have to pay attention else look like a complete fool.

Scott 8)

Hi Scott,

I have printed this off, the problem is, they still dont say which combination (at what amount) helps most people with MAV and we are still in the same situation of trial and error, in my case, mostly error! I must admit, when I tried a lot of the preventatives, it wasnt known that you could combine them, now that it is, I have to try and tell my dr. or specialist what to give me and I havent a clue!

Best Wishes

My guess would be a combo of an anticonvulsant and an antidepressant, like effexor. I have no idea why I think this, so please correct me :?

does the article say that vestibular migraines can be 24/7?

Great stuff!!

This is really good stuff - thanks Scott!