Vestibular migraine: progress in the search for treatments – Harvard Health Blog

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, light sensitivity, speech impairment, nausea, vomiting or dizziness. Although we now have many options to treat the headache associated with migraine, we are often helpless in treating these other associated neurological symptoms.

One of the most annoying neurological symptoms that patients report is dizziness or dizziness associated with migraine, a condition that we call vestibular migraine and where patients feel that they, or the environment around them, is running. We currently do not have adequate treatment for vestibular migraine.

What is vestibular migraine?

Vestibular migraine is often diagnosed when dizziness occurs during a migraine headache, or shortly before or after. It remains unclear what exactly causes vestibular migraine, but a hypothesis is that neural connections between the sensory systems that process headaches and the vestibular systems that establish a sense of spatial awareness and balance can communicate during a migraine attack.

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

Vagal nerve stimulation can reduce migraine-associated dizziness

Emerging research suggests that a new application of an existing treatment may be promising. The treatment, called non-invasive VNS (nVNS), involves placing a small hand 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 brain stem through your neck and regulates all organs in your body, including your heartbeat, intestinal motility and mood. Electrical stimulation of the vagus nerve is used to treat both epilepsy and depression. And there are indications that nVNS can effectively treat migraine headache, as well as dizziness that is not associated with migraine.

A recent study published in the journal Neurology tested whether nVNS could be used to treat dizziness symptoms in migraine patients. The study found that 13 out of 14 migraine patients using nVNS reported a significant improvement in vestibular symptoms that occurred during a migraine attack. The only side effect noted with this treatment was a slight twitching sensation in the neck during the electrical pulse. These results are consistent with several previous studies that demonstrate 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 can be an effective treatment for vestibular symptoms associated with migraine and should cause 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 ability to use nVNS to treat these symptoms in a safe, non-invasive manner. More research is needed before nVNS can be recommended as an effective treatment for vestibular migraine, but the promising results and absence of worrying side effects offer new hope to migraine sufferers.

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