Although data indicate that vestibular migraine (VM) is the most common neurologic cause of vertigo in adults, no FDA-approved agents exist for its treatment. With few studies having pursued rescue treatments for VM,. Shin C. Beh, MD, and colleagues sought to address this area of need to help their patients with VM. For a study published in Neurology, Dr. Beh and colleges analyzed the benefits of noninvasive vagus nerve stimulation (nVNS) treatment on acute VM. “Many patients are sensitive to, or concerned about, potential adverse effects of medications; a drug-free and efficacious therapy for VM would be a significant breakthrough for patient care,” says Dr. Beh.

The study was a retrospective chart review to determine if patients with VM experienced significant relief of their VM attack, after receiving nVNS. Patients graded their level of discomfort from vertigo and/or headache using a 0-10 point scale (0 = no pain, 10 = worst ever symptoms) before and 15 minutes after nVNS treatment. Patients with vertigo experienced a 92% relief rate (complete resolution in 14%, at least 50% improvement in 35%), dropping 46.9% in intensity, from a mean pre-nVNS level of 5.2 prior to 3.1 after. All patients reported improvement in headache after nVNS treatment, with a mean pre-treatment headache severity of 6and a mean post-nVNS score of 2.4. However, all VM patients with persistent perceptual postural dizziness reported no benefit with nVNS.

“It is important to emphasize that VM is a treatable condition, and that drug-free, safe, and effective treatment options like nVNS are available,” notes Dr. Beh. “The most likely explanation for the effects of nVNS on VM is the close link between the vagal, trigeminal, and vestibular systems in many brainstem nuclei, particularly the nucleus tractus solitarius, but that has not been proven. Our study was small and unblinded, and of course, a large, randomized-controlled trial is needed to investigate the role of nVNS in VM. However, specialists should be aware that nVNS is a therapeutic option that is highly tolerable, drug-free, safe and can be very efficacious in VM.”

References

Acute vestibular migraine treatment with noninvasive vagus nerve stimulation
https://n.neurology.org/content/93/18/e1715