The Comparison Between Prophylactic Agents for Vestibular Migraine and Its Prescribing Patterns
Abstract
Introduction: Vestibular migraine (VM) is a neurological condition characterized by recurrent vertigo episodes associated with migraine symptoms. These may include headache, sensitivity to light and sound, and visual aura. Though VM may or may not present with head pain, its impact on balance and motion perception significantly affects quality of life. Diagnosing VM is challenging due to overlap with other vestibular disorders.
Aim: To compare the efficacy and prescribing patterns of various prophylactic agents in reducing attack frequency, improving quality of life, and mitigating vestibular symptoms in patients diagnosed with vestibular migraine.
Objectives: Primary objective is to assess the reduction in episode frequency, duration, and severity, improving the overall quality of life. Secondary objective is to identify the extent of relief from vestibular and headache symptoms, and analyze the prescription trends across agents like Propranolol, Amitriptyline, Topiramate, Sodium Valproate, and Flunarizine.
Methodology: Diagnosis of VM requires clinical evaluation and exclusion of other disorders. Management is personalized, with topiramate, propranolol, and flunarizine providing symptom relief-topiramate being most effective for headaches. Vestibular rehab aids patients with anxiety or motion sensitivity.
Results: VM predominantly affected women (70%), especially in the 28–37 age group, with headache and giddiness as common symptoms. Triggers included sleep deprivation, stress, light sensitivity, and menstruation. Comorbidities like hypertension (8.75%) and diabetes (3.75%) were occasionally present. Prophylactic treatment yielded clinical improvement in 80.9% of cases. Medications such as propranolol (18.75%), amitriptyline (7.5%), and topiramate (3.75%) were commonly used, with combination therapy in 43.75% of patients. Topiramate was effective in reducing headache severity, while propranolol improved quality of life. Post-treatment, 76% of patients experienced mild pain, and 82.5% had reduced dizziness. Vestibular rehabilitation was particularly helpful for those with anxiety. A strong association between magnesium deficiency and migraine frequency was observed.
Conclusion: Diagnosis relies on thorough clinical assessment and exclusion of other vestibular disorders. Effective management involves individualized, multidisciplinary care. Topiramate, propranolol, and flunarizine offer symptom control, with topiramate most effective for headache reduction. Vestibular rehabilitation benefits patients, especially those with anxiety or motion sensitivity. Treatment is tailored to patient-specific factors, though standardized protocols are lacking due to limited large-scale trials
Keywords:
Vestibular Migraine, Prophylactic Therapy, Preventive Pharmacotherapy, Prescribing Patterns, Drug Utilization ReviewDOI
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