Celal Bayar University, Department of Neurology, Manisa, Turkey.
Department of Neurology, Ege University, Izmir, Turkey.
Neurol Res. 2022 Sep;44(9):847-854. doi: 10.1080/01616412.2022.2056341. Epub 2022 Mar 29.
To find out clinical features associated with poor response to treatment in vestibular migraine (VM).
VM patients treated with drugs recommended in migraine prophylaxis were included in this multicenter study. Migraine features including type, age of onset of headache and vertigo attacks, attack frequency, intensity, associated symptoms, triggering factors, presence of interictal dizziness/imbalance, anxiety, depression, history of motion sickness, and family history of migraine were noted. Amitriptyline, flunarizine, propranolol, topiramate and venlafaxine were chosen depending on patients' individual requirements. Maximum dose of each drug was tried for 2 months to decide its efficacy. In the case of inefficacy, it was changed with another preventive drug of different class. If there was still no improvement, two drugs of different classes were combined. ≥ 50% reduction in attack frequency and severity in patients using one drug and a combination of two drugs was compared, with patients showing <50% reduction despite combination therapy, regarding their clinical features.
The results of 430 VM patients, 65 men and 365 women with a mean age of 42.2 ± 12.2 years (range: 17-74 years), were analyzed.
Cutaneous allodynia frequently associated with female sex, comorbid anxiety and depression and interictal dizziness/imbalance enhanced with comorbid anxiety were risk factors for reduced treatment response. Aural fullness might be the clue of impending concomitant Meniere's disease not responding to migraine preventives.
找出与前庭性偏头痛（VM）治疗反应不佳相关的临床特征。
本多中心研究纳入了接受偏头痛预防药物治疗的 VM 患者。记录偏头痛特征，包括头痛和眩晕发作的类型、发病年龄、发作频率、强度、伴随症状、诱发因素、间歇期头晕/失衡、焦虑、抑郁、晕动病史和偏头痛家族史。根据患者的个体需求选择阿米替林、氟桂利嗪、普萘洛尔、托吡酯和文拉法辛。每种药物的最大剂量尝试 2 个月以确定其疗效。如果无效，则用另一种不同类别的预防药物替代。如果仍然没有改善，则联合使用两种不同类别的药物。比较使用一种药物和两种药物联合治疗的患者，其发作频率和严重程度降低≥50%，而联合治疗后仍无改善的患者，根据其临床特征进行比较。
对 430 例 VM 患者（65 名男性和 365 名女性，平均年龄 42.2±12.2 岁，范围：17-74 岁）的结果进行了分析。
皮肤感觉过敏与女性、共病焦虑和抑郁以及伴有焦虑的间歇期头晕/失衡频繁相关，是治疗反应降低的危险因素。耳胀满可能是偏头痛预防药物治疗无效的伴随梅尼埃病即将发生的线索。
