according to a small, open-label study published online Sept. 25 in Neurology.
The retrospective, single-center study included data from 18 patients who had vestibular migraine and received acute treatment with a handheld stimulation device. The device used in the study, GammaCore, is approved for the treatment of migraine. There are no approved treatments for vestibular migraine.
“There’s a huge need for effective treatments for vestibular migraine attacks,” first author Shin C. Beh, MD, said in a news release. “People with vestibular migraine do not always have headaches, and when they do, they are often less severe than in typical migraine, so the pain-relieving drugs used for typical migraine often are not effective. People can take drugs that suppress the vertigo or the nausea, but those drugs cause drowsiness and make it hard for people to go about their usual activities.” Dr. Beh is an assistant professor of neurology and neurotherapeutics at University of Texas Southwestern Medical Center in Dallas.
The patients had an average age of about 46 years, and 16 were women. A total of 14 patients received treatment during an acute vestibular migraine attack, and 4 received treatment while they had bothersome interictal dizziness consistent with persistent perceptual postural dizziness.
After stimulation, vertigo improved in 13 of the 14 people with vestibular migraine attacks. In two of these patients, vertigo resolved completely, and five had at least a 50% improvement in vertigo symptoms. On a 0-10 scale, patients’ mean vertigo rating decreased from 5.2 before stimulation to 3.1 after stimulation.
Of five patients with vestibular migraine attacks who had headache, all experienced a reduction in headache pain. Mean headache severity decreased from 6 before stimulation to 2.4 after stimulation.
None of the four patients with interictal dizziness experienced a reduction in dizziness after stimulation.
Patients place the device against the neck to receive electrical stimulation, and patients received stimulation for 2 minutes on each side of the neck.
Participants reported a mild pulling sensation of the neck muscles during the stimulation but did not report pain or other side effects.
“Vestibular migraine is the most common neurologic cause of vertigo and can greatly interfere with a person’s daily life,” Dr. Beh said. “If these results can be confirmed with larger studies, not only could there finally be a treatment for vestibular migraine, such a treatment would also be easy to use.”
A randomized, double-blind, sham-controlled study is needed to further assess the use of noninvasive vagus nerve stimulation in treating vestibular migraine, the authors said.
The study had no targeted funding, and Dr. Beh had no relevant disclosures. Coauthor Deborah I. Friedman, MD, professor of neurology and neurotherapeutics and ophthalmology at UT Southwestern Medical Center, disclosed serving on advisory boards or speaking for pharmaceutical and medical device companies. Dr. Friedman is on the editorial advisory board of Neurology Reviews.
SOURCE: Beh SC et al. Neurology. 2019 Sep 25. doi: 10.1212/WNL.0000000000008388.