Noninvasive Vagus Nerve Stimulation Shows Promise for Acute Vestibular Migraine

Shin C. Beh, MD, assistant professor of neurology and neurotherapeutics, and founding director, Vestibular Neurology and Neuro-Visual Disorders Clinic, UT Southwestern Medical Center

Shin C. Beh, MD

New study results have provided preliminary evidence of the success of noninvasive vagus nerve stimulation (nVNS) in providing quick relief to patients with acute vestibular migraine experiencing symptoms of vertigo and headache.¹

Additionally, coauthors Shin C. Beh, MD, assistant professor of neurology and neurotherapeutics, and founding director, Vestibular Neurology and Neuro-Visual Disorders Clinic, and Deborah I. Friedman, MD, MPH, professor of neurology, neurotherapeutics, and ophthalmology, both of UT Southwestern Medical Center, noted that these data are enough to warrant further randomized and sham-controlled studies of nVNS in vestibular migraine.

“There’s a huge need for effective treatments for vestibular migraine attacks,” Beh said in a statement.² “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.”

The study included 18 patients, of which 14 were treated for a vestibular migraine attack and 4 were treated for interictal persistent perceptual postural dizziness. The patients were an average of 45.7 years old (±14.8), and 16 of them were women. The retrospective chart review period was between November 2017 and January 2019, at a single tertiary referral center.

Out of 14 total patients, 2 with acute vestibular migraine experienced complete resolution of vertigo, with a ≥50% improvement in 5 patients, as measured by an 11-point visual analog scale (VAS; 0 being no symptoms, 10 being worst-ever symptoms) before and 15 minutes after nVNS. All told, 13 of the 14 experienced an improvement. The mean intensity of vertigo was improved by 2.1 points from a baseline of 5.2 (±1.6; median, 6) poststimulation. The mean reduction in intensity was 46.9% (±31.5; median 45%).

“Vestibular migraine is the most common neurologic cause of vertigo, and can greatly interfere with a person’s daily life,” Beh said in a statement. “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.”

As for headache, 5 patients reported experiencing it alongside their vestibular migraine attack, all of whom reported improvement following the use of nVNS. Prior to treatment, the mean severity of headache was 6 (±1.4; median, 6), reduced by 3.6 points to 2.4 (±1.5; median 3) following treatment with nVNS. The average reduction in headache intensity was 63.3% (±21.7; median 50).

The 4 patients treated with nVNS for interictal persistent perceptual postural dizziness reported no benefit.

Beh and Friedman acknowledged that the study, which was preliminary, had a number of limitations, including the small size, the lack of a control group, and its unblinded nature. Beh reiterated in a statement that a randomized, double-blind study including participants receiving sham stimulation is needed.

REFERENCES

1. Beh SC, Friedman DI. Acute vestibular migraine treatment with noninvasive vagus nerve stimulation. Neurology. Published online September 25, 2019. doi: 10.1212/WNL.0000000000008388.

2. DOES MIGRAINE LEAVE YOUR HEAD SPINNING? NON-INVASIVE TREATMENT SHOWS EARLY PROMISE [press release]. Minneapolis, MN: American Academy of Neurology; Published September 25, 2019. aan.com/PressRoom/Home/PressRelease/2749. Accessed October 4, 2019.