Vestibular migraine: Progress in the search for treatments

Headshot senior man with vertigo. Elderly male patient suffering from dizziness isolated on light blue background .

Nearly 15% of the world’s population has migraine, a condition in which moderate-to-severe headache is associated with neurological abnormalities such as visual dysfunction, sensitivity to light, disordered speech, nausea, vomiting, or dizziness. While we now have many options to treat the head pain associated with migraine, we are often helpless in treating these other associated neurological symptoms.

One of the most bothersome neurological symptoms patients report is vertigo or dizziness-associated with migraine, a condition we call vestibular migraine, and in which patients feel as though they, or the environment around them, is spinning. At present, we have no adequate treatment for vestibular migraine.

What is vestibular migraine?

Vestibular migraine is often diagnosed when vertigo occurs during a migraine headache, or shortly before or after one. It remains unclear precisely what causes vestibular migraine, but one hypothesis is that neural connections between the sensory systems, which process head pain, and the vestibular systems, which establish a sense of spatial awareness and balance, could communicate during a migraine attack.

Treatment options for vestibular migraine are extremely limited, so current treatment is focused primarily on reducing the frequency of migraine attacks.

Vagal nerve stimulation may reduce migraine-associated vertigo

Emerging research suggests that a new application of an existing treatment may hold some promise. The treatment, called noninvasive VNS (nVNS), involves placing a small handheld device over your neck to deliver a short electrical pulse to activate your vagus nerve. The vagus nerve is a long nerve that descends from your brainstem through your neck and regulates all organs in your body including your heart rate, gut motility, and mood. Electrical stimulation of the vagus nerve is used to treat both epilepsy and depression. And there is evidence that nVNS may effectively treat migraine headache, as well as vertigo not associated with migraine.

recent study published in the journal Neurology tested whether nVNS could be used to treat vertigo symptoms in migraine patients. The study found that 13 of 14 migraine patients who used nVNS reported significant improvement in the vestibular symptoms occurring during a migraine attack. The only side effect noted with this treatment was a slight tugging sensation on the neck during the electrical pulse. These results are consistent with multiple prior studies demonstrating that nVNS is safe.

It is important to note that a control group was not included in this study, so it is unclear to what extent vestibular improvement was due to nVNS itself, or to a combination of nVNS and a placebo effect. Nevertheless, this study provides exciting early data that nVNS may be an effective treatment for vestibular symptoms associated with migraine, and should prompt larger controlled trials in the future.

Where we are now

Because there are few treatment options available for vestibular symptoms associated with migraine, there is great excitement about the possibility of using nVNS to treat these symptoms in a safe, noninvasive way. More research is needed before nVNS can be recommended as an effective treatment for vestibular migraine, but its promising results and absence of worrisome side effects offer new hope to migraine patients.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

Luke 6:43-49  “For no good tree bears bad fruit, nor again does a bad tree bear good fruit, for each tree is known by its own fruit. For figs are not gathered from thornbushes, nor are grapes picked from a bramble bush. The good person out of the good treasure of his heart produces good, and the evil person out of his evil treasure produces evil, for out of the abundance of the heart his mouth speaks. “Why do you call me ‘Lord, Lord,’ and not do what I tell you? Everyone who comes to me and hears my words and does them, I will show you what he is like:

Matthew 5:3-10  “Blessed are the poor in spirit, for theirs is the kingdom of heaven. “Blessed are those who mourn, for they shall be comforted. “Blessed are the meek, for they shall inherit the earth. “Blessed are those who hunger and thirst for righteousness, for they shall be satisfied. “Blessed are the merciful, for they shall receive mercy. …

John 3:16 “For God so loved the world, that he gave his only Son, that whoever believes in him should not perish but have eternal life.

Proverbs 16:20 Whoever gives thought to the word will discover good, and blessed is he who trusts in the LORD.

Ecclesiastes 2:1-26 I said in my heart, “Come now, I will test you with pleasure; enjoy yourself.” But behold, this also was vanity. I said of laughter, “It is mad,” and of pleasure, “What use is it?” I searched with my heart how to cheer my body with wine—my heart still guiding me with wisdom—and how to lay hold on folly, till I might see what was good for the children of man to do under heaven during the few days of their life. I made great works. I built houses and planted vineyards for myself. I made myself gardens and parks, and planted in them all kinds of fruit trees. …

1 Corinthians 13:1-13 If I speak in the tongues of men and of angels, but have not love, I am a noisy gong or a clanging cymbal. And if I have prophetic powers, and understand all mysteries and all knowledge, and if I have all faith, so as to remove mountains, but have not love, I am nothing. If I give away all I have, and if I deliver up my body to be burned, but have not love, I gain nothing. Love is patient and kind; love does not envy or boast; it is not arrogant or rude. It does not insist on its own way; it is not irritable or resentful; …

Luke 11:28 But he said, “Blessed rather are those who hear the word of God and keep it!”

James 1:2 Count it all joy, my brothers, when you meet trials of various kinds,

Ecclesiastes 7:14 In the day of prosperity be joyful, and in the day of adversity consider: God has made the one as well as the other, so that man may not find out anything that will be after him.

1 Corinthians 13:4 Love is patient and kind; love does not envy or boast; it is not arrogant

Micah 6:8 He has told you, O man, what is good; and what does the LORD require of you but to do justice, and to love kindness, and to walk humbly with your God?

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