Salmito Márcio Cavalcante, Duarte Juliana Antoniolli, Morganti Lígia Oliveira Golçalves, Brandão Priscila Valéria Caus, Nakao Bruno Higa, Villa Thais Rodrigues, Ganança Fernando Freitas
Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
Braz J Otorhinolaryngol. 2017 Jul-Aug;83(4):404-410. doi: 10.1016/j.bjorl.2016.04.022. Epub 2016 Jun 2.
Vestibular migraine (VM) is now accepted as a common cause of episodic vertigo. Treatment of VM involves two situations: the vestibular symptom attacks and the period between attacks. For the latter, some prophylaxis methods can be used. The current recommendation is to use the same prophylactic drugs used for migraines, including β-blockers, antidepressants and anticonvulsants. The recent diagnostic definition of vestibular migraine makes the number of studies on its treatment scarce.
To evaluate the efficacy of prophylactic treatment used in patients from a VM outpatient clinic.
Review of medical records from patients with VM according to the criteria of the Bárány Society/International Headache Society of 2012 criteria. The drugs used in the treatment and treatment response obtained through the visual analog scale (VAS) for dizziness and headache were assessed. The pre and post-treatment VAS scores were compared (the improvement was evaluated together and individually, per drug used). Associations with clinical subgroups of patients were also assessed.
Of the 88 assessed records, 47 were eligible. We included patients that met the diagnostic criteria for VM and excluded those whose medical records were illegible and those of patients with other disorders causing dizziness and/or headache that did not meet the 2012 criteria for VM. 80.9% of the patients showed improvement with prophylaxis (p<0.001). Amitriptyline, Flunarizine, Propranolol and Topiramate improved vestibular symptoms (p<0.001) and headache (p<0.015). The four drugs were effective in a statistically significant manner. There was a positive statistical association between the time of vestibular symptoms and clinical improvement. There was no additional benefit in hypertensive patients who used antihypertensive drugs as prophylaxis or depressed patients who used antidepressants in relation to other prophylactic drugs. Drug association did not show statistically significant results in relation to the use of a single drug.
Prophylactic medications used to treat VM improve the symptoms of this disease, but there is no statistically significant difference between the responses of prophylactic drugs. The time of vestibular symptom seems to increase the benefit with prophylactic treatment.
前庭性偏头痛（VM）现已被公认为发作性眩晕的常见病因。VM的治疗涉及两种情况：前庭症状发作期和发作间期。对于后者，可采用一些预防方法。目前的建议是使用与偏头痛相同的预防性药物，包括β受体阻滞剂、抗抑郁药和抗惊厥药。最近前庭性偏头痛的诊断定义使得关于其治疗的研究数量稀少。
评估在一家VM门诊患者中使用预防性治疗的疗效。
根据2012年巴拉尼协会/国际头痛协会标准对VM患者的病历进行回顾。评估治疗中使用的药物以及通过头晕和头痛视觉模拟量表（VAS）获得的治疗反应。比较治疗前后的VAS评分（按所用药物分别及综合评估改善情况）。还评估了与患者临床亚组的相关性。
在88份评估记录中，47份符合条件。我们纳入了符合VM诊断标准的患者，排除了病历难以辨认的患者以及患有其他导致头晕和/或头痛但不符合2012年VM标准的疾病的患者。80.9%的患者预防性治疗后症状改善（p<0.001）。阿米替林、氟桂利嗪、普萘洛尔和托吡酯改善了前庭症状（p<0.001）和头痛（p<0.015）。这四种药物均有显著疗效。前庭症状持续时间与临床改善之间存在统计学上的正相关。使用抗高血压药物进行预防的高血压患者或使用抗抑郁药的抑郁症患者与使用其他预防性药物的患者相比，并无额外益处。联合用药与单一用药相比，未显示出统计学上的显著差异。
用于治疗VM的预防性药物可改善该病症状，但预防性药物的反应之间无统计学上的显著差异。前庭症状持续时间似乎会增加预防性治疗的获益。
