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Pharmacotherapy failure and progression to botulinum toxin injection in vestibular migraine

Published online by Cambridge University Press:  27 July 2020

Y F Liu ,
D Macias ,
L Donaldson ,
J R Dornhoffer  and
H G Rizk
Y F Liu
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
D Macias
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
L Donaldson
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
J R Dornhoffer
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
H G Rizk*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
*
Author for correspondence: Dr Habib G Rizk, 135 Rutledge Avenue, MSC 550, Charleston, SC29425, USA E-mail: rizkh@musc.edu Fax: +1 843 792 0546
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Abstract

Objective

Given the lack of evidence on patients with medically refractory vestibular migraine, this study aimed to identify factors associated with pharmacotherapy failure and progression to botulinum toxin injection in vestibular migraine.

Methods

A retrospective cohort study was conducted on definite vestibular migraine patients from September 2015 to July 2019 who completed the Dizziness Handicap Inventory at least six weeks apart..

Results

The study comprised 47 patients (mean age = 50.2 ± 15.8 years), with a mean follow-up time of 6.0 ± 6.0 months. The mean pre-treatment Dizziness Handicap Inventory score was 57.5 ± 23.5, with a mean reduction of 17.3 ± 25.2 (p < 0.001) at last follow up. Oscillopsia (r = 0.458, p = 0.007), failure of first medication (r = 0.518, p = 0.001) and pre-treatment Dizziness Handicap Inventory question 15 (an emotional domain question) score (r = 0.364, p = 0.019) were the only variables significantly correlated with progression to botulinum toxin injection.

Conclusion

Motion hypersensitivity, failure of first medication, and fear of social stigmatisation suggest a decreased treatment response. These symptoms may require more aggressive treatment at an earlier stage.

Keywords

Migraine DisordersBotulinum ToxinVestibular DiseasesEar Diseases
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 7 , July 2020 , pp. 586 - 591
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

Dr H G Rizk takes responsibility for the integrity of the content of the paper

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