Effects of vestibular rehabilitation in the management of patients with and without vestibular migraine

Koc, Ahmet; Akkılıc, Elvan Cevizci

doi:10.1016/j.bjorl.2021.07.011

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Brazilian Journal of Otorhinolaryngology

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Sumário

Original article • Braz. j. otorhinolaryngol. 88 (Suppl 3) • Nov-Dec 2022 • https://doi.org/10.1016/j.bjorl.2021.07.011 copy

Effects of vestibular rehabilitation in the management of patients with and without vestibular migraine

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

Vestibular Migraine (VM) is the second most common cause after Benign Paroxysmal Positional Vertigo in patients with vertigo.

Drugs used in migraine headaches are also used in the treatment of VM, but complaints of dizziness/vertigo may progress.

Vestibular Rehabilitation (VR) provide significant improvement in vestibular symptoms and quality of life in VM patients.

VR should be considered in addition to medical treatment in patients with vestibular migraine.

Abstract

Objective:

Vestibular Migraine (VM) is the second most common cause in patients with vertigo. Patients with VM complain about vestibular symptoms during a headache attack or during the period between attacks. Vestibular Rehabilitation (VR), an exercised based therapy to treat dizziness and balance dysfunction has been shown to be effective in vestibular diseases. In this study, we aimed to assess the effect of VR for vestibular symptoms and quality of life in VM patients, and to compare the results with patients with vestibular disorders without migraine.

Methods:

Sixty (60) patients who received VR treatment were divided into two groups: vestibular migraine group (30 patients) and non-migraine vestibular dysfunction group (30 patients). All patients received VR for 18 sessions and the program was completed in 1.5 months. Preand post-treatment Dizziness Handicap Inventory (DHI) scores, Vestibular Disorders Activities of Daily Living Scale (VADL) scores, the frequency of dizziness and headache, and Computerized Dynamic Posturography (CDP) scores were assessed and compared retrospectively.

Results:

With VR in both the vestibular migraine group and vestibular dysfunction group, DHI score, VADL score, the frequency of dizziness and headache scores significantly impaired. Post-treatment CDP results were higher than pre- treatment results for both patient groups.

Conclusion:

With VR, a significant improvement was observed in subjective and objective balance assessment measurement. Vestibular Rehabilitation must be considered in patients who do not benefit from medical therapy or have limited benefit.

Level of evidence: Level III (evidence obtained from well-designed controlled trials without randomization).

Keywords
Vestibular migraine; Vestibular rehabilitation; Vertigo

	Group
Characteristics of subjects	VM	VD
Number	30	30
Mean age (years)	46.13	56.50
Age range	30–64	38–76
Sex (male/female)	2/28	10/20
Time since onset of vestibular problems (months-mean)	9.3	10.2
Subjects with abnormal VHIT results (%)	33	35
Subjects with abnormal VNG results (%)	81	75

	VM Group		VD Group		p
	Mean±SD	median	Mean±SD	median
DHI Score
Before treatment	68.7±8.5	66.0	67.7± 19.5	62.0	0.654^a a Mann-Whitney U test.
After treatment	24.0±8.8	20.0	30.3±23.0	20.0	0.881^a a Mann-Whitney U test.
Intra group difference	0.000^b b Wilcoxon test.		0.000^b b Wilcoxon test.
VADL Score
Before treatment	99.5 ± 10.7	99.5	104.2±50.6	87.0	0.024^a a Mann-Whitney U test.
After treatment	37.5±8.6	37.5	53.7±44.0	40.5	1.000^a a Mann-Whitney U test.
Intra group difference	0.000^b b Wilcoxon test.		0.000^b b Wilcoxon test.

Condition	Pre-treatment			post-treatment			p
	Mean ± SD	Median	Range (min-max)	Mean±SD	Median	Range (min-max)
C1	74.2 ± 13.9	74.0	52.7–93.9	91.9±0.8	92.3	90.8–92.7	0.000^a a Wilcoxon test.
C2	62.8± 18.9	61.0	24.3–91.3	88.6±0.7	88.6	87.7–89.3	0.000^a a Wilcoxon test.
C3	48.2 ±29.0	48.0	00.0–90.5	80.3±4.8	81.9	73.9–85.0	0.000^a a Wilcoxon test.
C4	49.6±23.6	55.9	00.0–77.0	76.5±0.8	77.0	75.4–77.1	0.000^a a Wilcoxon test.
C5	32.8 ± 15.4	32.7	00.0–61.2	65.0±5.5	63.6	59.5–72.4	0.000^a a Wilcoxon test.
C6	8.4± 13.4	0.0	00.0–48.7	32.3 ±15.7	32.9	13.1–50.8	0.000^a a Wilcoxon test.

Condition	Pre-treatment			Post-treatment			p
	Mean ± SD	Median	Range (min-max)	Mean±SD	Median	Range (min-max)
C1	84.2 ± 16.3	90.0	31.6–96.7	93.2 ± 3.5	92.3	89.4–97.8	0.002^a a Wilcoxon test.
C2	74.1 ±25.5	85.4	9.8–94.8	88.3 ±7.1	91.9	85.0–97.9	0.021^a a Wilcoxon test.
C3	72.1 ± 17.5	71.5	37.9–95.6	86.3±6.2	88.4	78.5–94.5	0.000^a a Wilcoxon test.
C4	51.7 ± 14.9	52.6	28.3–79.0	66.1 ±7.1	64.0	58.5–75.6	0.000^a a Wilcoxon test.
C5	27.9± 15.8	28.0	00.0–50.4	55.2 ± 12.6	63.2	37.8–64.7	0.000^a a Wilcoxon test.
C6	11.7± 14.8	6.8	00.0–50.5	30.8±0.7	30.4	30.2–31–7	0.000^a a Wilcoxon test.

Condition	Pre-treatment			Post-treatment			p
	Mean ± SD	Median	Range (min-max)	Mean±SD	Median	Range (min-max)
C1	73.5 ± 10.8	73.5	48.7–91.4	82.9 ± 9.3	85.3	70.5–93.2	0.001^a a Wilcoxon test.
C2	64.3 ± 19.1	64.2	17.7–89.5	78.4± 15.9	81.5	39.3–94.9	0.003^a a Wilcoxon test.
C3	49.9 ±21.3	48.0	00.0–80.7	65.1 ±21.5	70.9	16.1–85.6	0.002^a a Wilcoxon test.
C4	57.5 ± 10.7	57.5	34.1–78.1	69.5±9.5	70.0	50.3–83.1	0.000^a a Wilcoxon test.
C5	40.3 ± 14.9	40.1	2.4–65.0	52.7± 15.4	52.8	26.1–74.8	0.004^a a Wilcoxon test.
C6	16.3 ± 14.4	16.3	00.0–45.7	34.6± 17.4	38.0	00.0–59.1	0.001^a a Wilcoxon test.

Condition	Pre-treatment			Post-treatment			p
	Mean ± SD	Median	Range (min-max)	Mean±SD	Median	Range (min-max)
C1	83.8± 12.1	83.8	48.00–97.80	92.1 ±4.2	92.6	85.3–97.7	0.000^a a Wilcoxon test.
C2	80.3 ± 14.7	80.2	21.50–96.50	85.0± 11.6	87.8	58.3–95.9	0.106^a a Wilcoxon test.
C3	73.5 ± 17.8	73.5	00.0–95.60	84.3 ±9.1	84.8	62.6–97.0	0.001^a a Wilcoxon test.
C4	52.4± 16.9	52.8	00.0–75.90	64.1 ± 15.6	65.5	30.1–79.8	0.004^a a Wilcoxon test.
C5	28.4± 12.8	27.0	00.0–51.80	43.7± 15.1	42.7	25.9–71.3	0.001^a a Wilcoxon test.
C6	10.2 ± 13.4	10.1	00.0–57.20	33.7± 17.0	34.1	00.0–65.1	0.000^a a Wilcoxon test.

	Pre-treatment (AP)			Post-treatment (AP)			p
	Mean ± SD	Median	Range	Mean±SD	Median	Range
Somatosensorial score	78.7± 14.7	82.0	46.2–90.0	90.0±0.0	90.0	88.1–92.5	0.000^a a Wilcoxon test.
Visual score	66.2 ±20.8	77.0	25.3–84.1	82.7± 1.9	84.0	80.0–84.2	0.000^a a Wilcoxon test.
Vestibular score	44.8± 16.0	46.0	11.2–62.0	59.7±3.4	62.0	55.2–62.1	0.000^a a Wilcoxon test.
Preferential score	58.1 ±20.8	65.0	19.4–77.0	68.7± 10.6	75.0	54.3–77.0	0.042^a a Wilcoxon test.
Global score	47.1 ±11.5	48.0	25.5–63.1	63.0±2.9	65.0	59.4–65.0	0.000^a a Wilcoxon test.

	Pre-treatment (ML)			Post-treatment (ML)			p
	Mean ± SD	Median	Range	Mean±SD	Median	Range
Somatosensorial score	85.7± 17.4	96.0	37.1–97.1	97.0 ±0.0	98.0	97.0–97.0	0.000^a a Wilcoxon test.
Visual score	59.2 ± 15.5	62.0	26.2–75.0	67.7±7.8	71.0	57.1–75.0	0.038^a a Wilcoxon test.
Vestibular score	39.9 ± 17.4	41.0	00.1–55.4	46.3± 12.5	53.0	29.2–55.1	0.263^a a Wilcoxon test.
Preferential score	68.3 ±7.7	70.0	48.0–74.1	70.7±4.8	74.0	64.5–74.1	0.388^a a Wilcoxon test.
Global score	52.5 ±8.9	52.0	39.1–67.0	62.0±5.2	64.0	55.0–67.2	0.000^a a Wilcoxon test.

	Pre-treatment (AP)			Post-treatment (AP)			p
	Mean ± SD	Median	Range	Mean±SD	Median	Range
Somatosensorial score	82.3 ±9.4	82.0	61.1–90.0	87.1 ±7.9	90.0	64.1–90.2	0.025^a a Wilcoxon test.
Visual score	75.1 ±8.9	75.0	50.2–84.1	81.1 ±6.0	84.0	64.0–84.4	0.007^a a Wilcoxon test.
Vestibular score	49.9± 14.7	51.0	7.2–62.5	57.9± 10.3	62.0	58.0–63.2	0.008^a a Wilcoxon test.
Preferential score	52.9 ±5.8	55.0	26.4–77.4	61.6± 15.7	65.0	26.1–77.1	0.007^a a Wilcoxon test.
Global score	52.0± 10.1	53.0	25.2–69.0	53.7± 11.0	54.0	34.2–69.0	0.531^a a Wilcoxon test.

	Pre-treatment (ML)			Post-treatment (ML)			p
	Mean±SD	Median	Range	mean±SD	Median	Range
Somatosensorial score	93.3±4.2	94.0	82.1–97.0	95.8±2.8	97.0	88.0–97.1	0.003^a a Wilcoxon test.
Visual score	61.6± 13.9	60.0	31.0–75.1	72.3±3.2	73.5	68.1–75.2	0.000^a a Wilcoxon test.
Vestibular score	36.5 ± 14.1	37.0	00.1–55.4	45.8±8.4	47.5	33.1–55.0	0.006^a a Wilcoxon test.
Preferential score	68.5± 10.5	70.0	21.1–74.4	72.5±2.4	73.5	66.2–74.0	0.011^a a Wilcoxon test.
Global score	53.58.6	53.5	24.0–67.3	58.1±8.8	58.5	40.1–67.1	0.040^a a Wilcoxon test.

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
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[1] * Corresponding author. E-mail: ahmetkoc2010@yahoo.com (A. Koc).