Despite being the most common neurologic cause of vertigo in adults, no FDA-approved treatments are available for vestibular migraine (VM) and few studies have assesses possibly effective rescue treatments. “There is a tremendous need for research into acute vestibular migraine therapies,” says Shin C. Beh, MD. “Furthermore, because many patients are sensitive to, or concerned about, potential adverse effects of medications, a drug-free and efficacious therapy for VM would be a significant breakthrough for patient care.”
For a single-center, retrospective review published in the Journal of Neurological Sciences, Dr. Beh treated 19 patients who had acute VM attacks with 20 minutes of external trigeminal nerve stimulation (eTNS) between May 2018 and June 2019. Before and after treatment, participants graded the severity of their vertigo/headache using a 10-point visual analog scale, with 0 representing no vertigo/headache and 10 representing the worst imaginable vertigo/headache.
All patients reported improvements in vertigo severity, with a 61.3% mean improvement from 6.6 prior to eTNS to 2.7 after. Among the 14/19 participants who experienced headache during VM episodes, headache severity improved a mean of 77.2%, from 4.8 before eTNS to 1.4 following treatment. Some patients also experienced improvements in eye pressure, head pressure, and chronic facial pain. No intolerable side effects of eTNS were reported.
“The most likely explanation for the effects of eTNS on VM is the close link between the trigeminal and vestibular systems in many brainstem nuclei,” explains Dr. Beh. “I believe that eTNS alters trigeminal input (via the ophthalmic branch of the trigeminal) to these brainstem nuclei and stops the neural activity responsible for generating a VM attack. “It is important to emphasize that VM is a treatable condition and that novel, drug-free, non-invasive, safe, and effective treatment options like eTNS are available. My small, unblended study provides clinicians with evidence of another potential option to help their patients with VM and supports the link between vertigo and migraine pathophysiology in the disorder.”
Rebecca Shover