From the Departments of Neurology (S.C.B., D.I.F.) and Ophthalmology (D.I.F.), UT Southwestern Medical Center, Dallas, TX.
Neurology. 2019 Oct 29;93(18):e1715-e1719. doi: 10.1212/WNL.0000000000008388. Epub 2019 Sep 25.
To report on the benefits of noninvasive vagus nerve stimulation (nVNS) on acute vestibular migraine (VM) treatment.
This was a retrospective chart review of patients with VM treated with nVNS in a single tertiary referral center between November 2017 and January 2019. Eighteen patients (16 women) were identified (mean age 45.7 [±14.8] years); 14 were treated for a VM attack and 4 for bothersome interictal dizziness consistent with persistent perceptual postural dizziness (PPPD). Patients graded the severity of vestibular symptoms and headache using an 11-point visual analog scale (VAS; 0 = no symptoms, 10 = worst ever symptoms) before and 15 minutes after nVNS.
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 headache 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.
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.
This study provides Class IV evidence that for patients with acute VM, nVNS rapidly relieves vertigo and headache.
报告非侵入性迷走神经刺激（nVNS）在急性前庭性偏头痛（VM）治疗中的益处。
这是对 2017 年 11 月至 2019 年 1 月期间在一家三级转诊中心接受 nVNS 治疗的 VM 患者进行的回顾性图表分析。共确定了 18 名患者（16 名女性）（平均年龄 45.7 [±14.8] 岁）；14 名患者因 VM 发作而接受治疗，4 名患者因持续性感知姿势性头晕（PPPD）引起的烦人的间歇性头晕而接受治疗。患者在 nVNS 前和 15 分钟后使用 11 点视觉模拟量表（VAS；0 = 无症状，10 = 症状最严重）对前庭症状和头痛的严重程度进行评分。
在急性 VM 患者中，14 例中的 13 例（2 例完全缓解，5 例至少改善 50%）眩晕得到改善。nVNS 前眩晕强度的平均值为 5.2（±1.6；中位数 6），刺激后为 3.1（±2.2；中位数 3）；眩晕强度平均降低 46.9%（±31.5；中位数 45%）。5 例 VM 发作时伴有头痛，所有患者在 nVNS 后均有改善。治疗前头痛严重程度的平均值为 6（±1.4；中位数 6），nVNS 后为 2.4（±1.5；中位数 3）；头痛强度平均降低 63.3%（±21.7；中位数 50%）。4 例因间歇性 PPPD 而接受 nVNS 治疗的患者均未报告受益。
我们的研究初步表明，nVNS 可能为急性 VM 患者迅速缓解眩晕和头痛，支持进一步对 VM 患者进行随机、假对照 nVNS 研究。
本研究提供了 IV 级证据，表明对于急性 VM 患者，nVNS 可迅速缓解眩晕和头痛。
