Nerve Stimulation May Quickly Treat Acute Vestibular Migraine Attacks, Post-Attack Symptoms

Noninvasive vagus nerve stimulation (nVNS) can treat vertigo and headache symptoms within 15 minutes of an acute vestibular migraine attack, according to preliminary evidence from a new study.

To assess the treatment option’s effectiveness for acute vestibular migraine, the researchers identified 18 patients with the condition who had been treated with nVNS in a single tertiary referral center between November 2017 and January 2019. 

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Of these patients, 14 had been treated for a vestibular migraine attack and 4 had been treated for bothersome interictal dizziness consistent with persistent perceptual postural dizziness.

The patients—who had a mean age of 45.7 years, and 16 of whom were women—graded the severity of their vestibular symptoms and headache before receiving nVNS and then again 15 minutes after the treatment. The grade was based on an 11-point visual analog scale, with 0 being “no symptoms” and 11 being “worst symptoms ever.”

Among the 14 patients with acute vestibular migraine, 13 experienced improvement in vertigo symptoms with nVNS. While 2 of these patients had complete resolution, 5 others had at least a 50% improvement in vertigo symptoms. Before nVNS, the mean vertigo intensity was 5.2; after the stimulation, the mean intensity grade was 3.1. In all, there was a 46.9% mean reduction in vertigo intensity with nVNS.

Of the patients with acute vestibular migraine, 5 had experienced a headache with their attack. All of these patients experienced improvement in headache after nVNS. Before the stimulation, the mean headache severity was 6.0; after nVNS, the mean headache severity among these patients was 2.4. In all, there was a 63.3% mean reduction in headache intensity.

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

“Our study provides preliminary evidence that nVNS may provide rapid relief of vertigo and headache in acute [vestibular migraine], and supports further randomized, sham-controlled studies into nVNS in [vestibular migraine],” the researchers concluded.

—Colleen Murphy

Reference:

Beh SC, Friedman DI. Acute vestibular migraine treatment with noninvasive vagus nerve stimulation. Neurology. 2019;93(18). doi:10.1212/WNL.0000000000008388.