Noninvasive nerve stimulation may relieve vertigo in vestibular migraine

USA: Noninvasive vagus nerve stimulation (nVNS) may provide relief to patients suffering from vestibular migraine -- a type of migraine in which patients experience dizziness and vertigo with or without headache pain, according to results published in AAN journal Neurology.

This noninvasive technique could be a promising treatment for patients with vestibular migraine, a condition for which there are currently no approved treatments.

The study led by Shin C. Beh, University of Texas Southwestern Medical Center in Dallas, aimed to report on the benefits of noninvasive vagus nerve stimulation on acute vestibular migraine treatment.

The retrospective study involved 18 people (mean age 45.7 [±14.8] years; 16 women) with vestibular migraine. None of them had a history of other conditions that can cause vertigo. 14 were treated for a VM attack and 4 for bothersome interictal dizziness consistent with persistent perceptual postural dizziness (PPPD).

The severity of vestibular symptoms and headache was graded using an 11-point visual analog scale (VAS; 0 = no symptoms, 10 = worst-ever symptoms) before and 15 minutes after nVNS.

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Key findings include:

• In those with acute VM, vertigo improved in 13/14 (complete resolution in 2, at least 50% improvement in 5).


• The mean vertigo intensity before nVNS was 5.2 (±1.6; median 6), and 3.1 (±2.2; median 3) following stimulation; mean reduction in vertigo intensity was 46.9% (±31.5; median 45%).


• Five experienced headaches with the VM attack; all reported improvement following nVNS.


• Mean headache severity was 6 (±1.4; median 6) prior to treatment and 2.4 (±1.5; median 3) following nVNS; mean reduction in headache intensity was 63.3% (±21.7; median 50).


• All 4 treated with nVNS for interictal PPPD reported no benefit.


• The participants reported a mild pulling sensation of the neck muscles during the stimulation but did not report any pain or other side effects.

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

"Our study provides preliminary evidence that nVNS may provide rapid relief of vertigo and headache in acute VM, and supports further randomized, sham-controlled studies into nVNS in VM," concluded the authors.

To read the complete study log on to https://doi.org/10.1212/WNL.0000000000008388