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A systematic review and meta-analysis of prophylactic medication of vestibular migraine

Published online by Cambridge University Press:  06 October 2022

C Yiannakis Open the ORCID record for C Yiannakis [Opens in a new window] ,
L Hamilton ,
M Slim  and
G Kontorinis
C Yiannakis*
Affiliation:
Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
L Hamilton
Affiliation:
Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
M Slim
Affiliation:
Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
G Kontorinis
Affiliation:
Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
*
Corresponding author: Dr C Yiannakis; E-mail: c.yiannakis@nhs.net
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Abstract

Objective

Vestibular migraine is in the process of recognition as an individual clinical entity. At present, no guidelines exist for its management. This study aimed to conduct a systematic review and meta-analysis to determine the effectiveness of available prophylactic medication.

Method

A literature search was performed using PubMed, Ovid and Embase databases. Qualitative and quantitative analysis were performed as well as risk of bias analysis. Meta-analysis for the mean differences for pre- and post-treatment impact based on Dizziness Handicap Inventory and Vertigo Symptom Scale were performed. Proportionate transformation meta-analysis for the successful event rate based on complete symptoms control was explored.

Results

Thirteen publications were identified: 3 were randomised, controlled trials and 10 were non-randomised, controlled trials. Propranolol and venlafaxine improved the Vertigo Symptom Scale score by −13.31 points and −4.16 points, respectively, and the Dizziness Handicap Inventory score by −32.24 and −21.24, respectively. Only propranolol achieved statistically significant impact with 60 per cent of patients achieving complete symptom control.

Conclusion

Propranolol should be offered as the first-line treatment for vestibular migraine followed by venlafaxine. Amitriptyline, flunarizine and cinnarizine showed a trend for symptom improvement, but this was not statistically significant.

Keywords

Migrainevertigopropranololvenlafaxine hydrochloridedizzinesstherapeutics
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 9 , September 2023 , pp. 953 - 961
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr C Yiannakis takes responsibility for the integrity of the content of the paper

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