Topiramate for the Management of Vestibular Migraine

Abstract

Objectives:Vestibular migraine (VM) is considered to be the second most‐common cause of vertigo and the most common cause of spontaneous episodic vertigo. Topiramate has been used effectively for the prevention of migraine headaches, however, there are few quality studies showing its effectiveness for the prophylaxis of VM. We seek to determine the efficacy of topiramate for the treatment of VM.Methods:Retrospective chart review over a 24‐month period (2010‐2012) of patients evaluated at a tertiary neurotology clinic. A coding query was performed to identify potential patients with a diagnosis of VM. Records were reviewed for diagnostic criteria for VM and the use of topiramate as a primary prophylactic treatment. The subjective reduction in the frequency and severity of vertigo attacks was the primary measured outcome.Results:Of 109 patients identified with a diagnosis of vestibular migraine, 30 (27.5%) met the accepted diagnostic criteria for probable vestibular migraine and 22 (20.2%) met criteria for definite vestibular migraine. Nineteen (19) of those patients were treated with topiramate, out of which 13 (68%) reported significant improvement in the frequency or severity of vertigo attacks during a 10 month average follow up. Two patients discontinued topiramate due to side effects despite efficacy. No medication adverse events occurred on these patients.Conclusions:Given its safety and efficacy in classic migraine prophylaxis, topiramate has been proposed as a treatment for VM. Data from this preliminary cohort supports its role in vestibular migraine prophylaxis. Larger, prospective studies are needed to confirm these findings.