24 January 2020

New hope against a 'dizzying' form of migraine

A preliminary study of migraine patients found that stimulating the vagus nerve in the neck can help relieve vertigo.

People who suffer bouts of vertigo and dizziness may be suffering from a type of migraine for which treatments rarely work.

But a new, preliminary study of 18 such patients found that stimulating the vagus nerve in the neck can help relieve vertigo.

Off balance and nauseous

"Vestibular migraine can occur with or without headache. It's an uncomfortable feeling, an abnormal sense of motion. A lot of people say that they feel like they're spinning," explained Dr Deena Kuruvilla, an assistant professor of neurology at Yale University.

Patients feel like they're off balance and may be nauseous. "It's an incredibly disabling disorder," said Kuruvilla, who was not involved in the study.

It's a tricky condition to diagnose, she added. "Nine times out of 10, patients get misdiagnosed," so people are best off seeing a neurologist or a headache specialist, Kuruvilla said.

However, the new treatment might help ease the condition, the authors of the new study said.

"Noninvasive vagus nerve stimulation that's approved for migraines and cluster headaches also relieves vertigo in patients with vestibular migraine," said lead researcher Dr Shin Beh. He's an assistant professor of neurology at the University of Texas Southwestern Medical Center, in Dallas.

Stimulating the vagus nerve appears to calm down centres in the brain that cause migraine and vertigo, he explained.

Less pain after treatment

Vestibular migraine is not curable, Beh said, "but this adds another possible treatment."

The stimulation is delivered via a handheld device placed against the neck during a vestibular migraine attack. The device that delivers electrical impulses to the nerve is regularly used to treat typical migraines.

Among the study participants, 14 patients were treated during a vestibular migraine attack, and four patients were treated for persistent dizziness between attacks.

After the nerve stimulation, 13 of the 14 patients had an improvement in their vertigo. In this group, two had their vertigo disappear and five experienced a 50% reduction in symptoms, the researchers found.

In addition, the five patients whose attack had an associated headache all reported less pain after the treatment.

How long the effect of the nerve stimulation lasts isn't known, Beh said. The study wasn't designed to see if nerve stimulation prevents future attacks.

It's also possible that the effect could be heightened if it's used in combination with migraine medications, he suggested.

Prohibitive cost

Unfortunately, none of the patients treated for persistent dizziness between attacks experienced any improvement.

The only discomfort from the treatment was a mild pulling sensation of the neck muscles, the researchers noted.

The study is limited by its small size and the fact that all of the patients received the real treatment, so the results can't be compared with people given sham treatment, Beh said.

The findings were published online in the journal Neurology.

Kuruvilla said, "I don't think the study had enough people in it to draw such a dramatic conclusion to say that each of these vertigo attacks, these dizziness attacks, are going to be completely cured with this device."

Another drawback is the cost of the device. "The monthly cost that the company has put on the device has made it really prohibitive for the majority of people," she added.

According to Kuruvilla, the monthly fees can run as high as $600 (±R8 600), and the treatment isn't covered by insurance.

Image credit: iStock


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Headache expert

Dr Elliot Shevel is a South African migraine surgery pioneer and the founder and medical director of The Headache Clinic in Johannesburg, Durban and Cape Town, South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team. He recently won a high level science debate in which he was able to prove that the current migraine diagnosis and classification is not based on data. Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon. Follow the Headache Clinic on Twitter@HeadacheClinic.

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