Table 3.
Migraine pharmacological treatments, effective in vestibular migraine
| Reference | Year | Study type | Follow-up time | Preventive | Dose | N | Vertigo active | Vertigo control | Headache active | Headache control |
| Reploeg | 2002 | Observational, sequential | >1 month | Nortriptyline + diet | 10–50 mg | 31 | 31 Resolution or 75% reduction in frequency | 13 Resolution with diet | NA | NA |
| >1 month | Nortriptyline + Atenolol | 25–50 mg | 19 | 21 Reduction or 75% reduction in Frequency | ||||||
| >1 month | Nortriptyline + Atenolol + Calcium-channel blocker + Neurology review | UNK | 18 | |||||||
| Bisdorff | 2004 | Observational, open-Label | 3–4 months | Lamotrigine | 100 mg | 19 | Frequency reduced from 18 to 5 | NA | Frequency reduced from 9 to 4 | NA |
| Gode | 2010 | Randomised, open-label | 6 months | Topiramate | 50 vs. 100 mg | 26 | Reduction in vertigo frequency and severity (P < 0.05) | Reduction in headache frequency and severity (P < 0.05) | ||
| Mikulec | 2012 | Retrospective, sequential | UNK | Nortriptyline vs. diet modification | 25–75 mg | 24 | Reduction in dizziness in 46% (P < 0.05) | Reduction in 14% of participants (US) | Reduction in 14% of participants (US) | |
| UNK | Topiramate vs. diet modification | 50–100 mg | 22 | Reduction in dizziness in 25% (P = 0.442) | Reduction in 14% of participants (US) | Reduction in headache in 25% (P = 0.442) | Reduction in 14% of participants (US) | |||
| Lepcha | 2013 | Open-label | 3 months | Flunarizine + (betahistine + paracetamol during attacks) | 10 (F), 16 (B), 1000 (P) mg | 25 | Reduced frequency and severity of vertigo (P < 0.05) | NA | NS | NA |
| Taghdiri | 2014 | Retrospective | 3 months | Cinnarizine | 37.5–75 mg | 24 | Reduction in attack frequency (P < 0.05) | NA | Reduction in Frequency, duration and severity (P < 0.05) | NA |
| Van Ombergen | 2014 | Retrospective | UNK | Flunarizine | 10 mg | 30 | Improvement in VM symptoms in 68% (P < 0.001) | NA | NA | NA |
| UNK | Propranolol | 80 mg | 31 | Improvement in VM symptoms in 73% (P < 0.001) | NA | NA | NA | |||
| Salviz | 2015 | Randomised, open-label | 4 months | Propranolol | 40–160 mg | 26 | Reduction in DHE, attack frequency and VAS (NS between groups) | Reduction in DHE, attack frequency and VSS (NS between groups) | NA | NA |
| Randomised, open-label | 4 months | Venlafaxine | 37.5–150 mg | 26 | Reduction in DHE, attack frequency and VAS (NS between groups) | Reduction in DHE, attack frequency and VSS (NS between groups) | NA | NA | ||
| Teggi | 2015 | Observational, Open-Label | 6 months: three times 1 month active drug intercalated with 1 month without | Cinnarizine & Dimenhydrinate vs. Lifestyle measures | 20 mg (C), 40 mg (D) | 22 | Reduction in vertigo frequency (P < 0.001) | Reduction in vertigo frequency (P < 0.05) | Reduction in vertigo frequency (P < 0.001) | Reduction in vertigo frequency (P = 0.06) |
| Salmito | 2016 | Retrospective | 3 months | Amitriptyline | 20–50 mg | 15 | Reduction in VAS vestibular symptoms (P < 0.001), similar between groups | NA | Reduction in VAS vestibular symptoms (P < 0.001), similar between groups | NA |
| Flunarizine | 10 mg | 11 | ||||||||
| Propranolol | 40–80 mg | 7 | ||||||||
| Topiramate | 100–200 mg | 8 | ||||||||
| Yuan | 2016 | Randomised | 3 months | Flunarizine and betahistine | 12 mg (B) ±10 mg (F) | 23 | Reduction in frequency, duration and severity (P < 0.05) | Reduction in frequency, duration and severity (P < 0.05) | NA | NA |
| Liu | 2017 | Single-blinded | 3 months | Venlafaxine | 37.5 mg | 23 | Reduced DHI (P < 0.05) attack frequency and VSS (P < 0.001) | NA | NA | NA |
| 3 months | Flunarizine | 10 mg | 22 | Reduced DHI-f,p,t and VSS (P < 0.05) but not frequency (P = 0.057) | NA | NA | NA | |||
| 3 months | Valproic Acid | 1000 mg | 20 | Reduced DHI-f,p,t (P < 0.05) and Frequency (P < 0.001), but no VSS (P = 0.27) | NA | NA | NA | |||
| Bayer | 2019 | Randomized, placebo-controlled | 6 months | Metoprolol | 95 mg | 60 | Nonsignificant reduction in additional monthly rate of attack incidence | Reduction in additional monthly rate of attack incidence | Headache frequency not obtained at baseline | Headache frequency not obtained at baseline |
| Celik | 2020 | Prospective, open-label | 6–32 months | Propranolol | 40–60 mg | 38 | Reduction of DHI and VADL (P < 0.001) | NA | NA | NA |
| Dominguez-Duran | 2020 | Randomized per algorithm, open-Label | 5 weeks | Acetazolamide | 250 mg | 5 | Reduction in frequency and VAS vestibular symptoms (P < 0.001), similar between groups | NA | Reduction in headache symptoms per VAS (P < 0.001), similar between groups | NA |
| Amitriptyline | 10 mg | 16 | ||||||||
| Flunarizine | 5 mg | 1 | ||||||||
| Propranolol | 10 mg | 4 | ||||||||
| Topiramate | 25 mg | 5 | ||||||||
| Gorur | 2020 | Open-label | 3 months | Botox + (A, P, F) | 155 IU | 10, 11, 9 | Reduced vertigo frequency and DHI (P < 0.001) | NA | Reduced MIDAS (P < 0.001) | NA |
| 3 months | Propranolol | ≤80 mg | 9 | Reduced vertigo frequency and DHI (P < 0.001) | NA | Reduced MIDAS (P < 0.001) | NA | |||
| 3 months | Amitriptyline | 25–75 mg | 10 | Reduced vertigo frequency and DHI (P < 0.001) | NA | Reduced MIDAS (P < 0.001) | NA | |||
| 3 months | Flunarizine | 10 mg | 11 | Reduced vertigo frequency and DHI (P < 0.001) | NA | Reduced MIDAS (P < 0.001) | NA | |||
| Hoskin | 2022 | Retrospective | NS | Erenumab | NS | 11 | Improvement in 21/25, moderate-significant in 15/25 (NS) | NA | Improvement in 21/25, moderate-significant in 15/25 (NS) | NA |
| Fremanezumab | 9 | |||||||||
| Galcanezumab | 6 | |||||||||
| Ubrogepant | 2 | |||||||||
| Lovato | 2023 | Observational, open-Label | Mean 26 weeks | Erenumab vs. previous preventives | 140 mg | 23 | Reduction in DHI, (P < 0.001) and VNG abnormalities (P = 0.002) | NA | Reduction in mean migraine days (P = 0.001) | NA |
| Mean 28 weeks | Propranolol | 40–80 mg | 12 | Reduction in DHI, (P = 0.2) | NA | Reduction in mean migraine days (P = 0.2) | NA | |||
| Flunarizine | 5 mg | 7 | ||||||||
| Valproic acid | 500–800 mg | 4 | ||||||||
| Russo | 2023 | Prospective, open-label | 12 months | Erenumab | 140 mg | 7 | Reduction in mean monthly days with dizziness (P < 0.001) | NA | Reduction in migraine monthly frequency (P < 0.001) | NA |
| Fremanezumab | 225 mg | 25 | ||||||||
| Galcanezumab | 240 initial, then 120 mg | 18 |
DHI, Dizziness Handicap Inventory; E emotional; F functional; NA not applicable; NS, not significant; P physical; VAS, visual analogue scale; VM, vestibular migraine.