Acute vestibular migraine treatment with noninvasive vagus nerve stimulation

Objective To report on the benefits of noninvasive vagus nerve stimulation (nVNS) on acute vestibular migraine (VM) treatment. Methods This was a retrospective chart review of patients with VM treated with nVNS in a single tertiary referral center between November 2017 and January 2019. Eighteen patients (16 women) were identified (mean age 45.7 [+/- 14.8] years); 14 were treated for a VM attack and 4 for bothersome interictal dizziness consistent with persistent perceptual postural dizziness (PPPD). Patients graded the severity of vestibular symptoms and headache using an 11-point visual analog scale (VAS; 0 = no symptoms, 10 = worst ever symptoms) before and 15 minutes after nVNS. Results In those with acute VM, vertigo improved in 13/14 (complete resolution in 2, at least 50% improvement in 5). The mean vertigo intensity before nVNS was 5.2 (+/- 1.6; median 6), and 3.1 (+/- 2.2; median 3) following stimulation; mean reduction in vertigo intensity was 46.9% (+/- 31.5; median 45%). Five experienced headache with the VM attack; all reported improvement following nVNS. Mean headache severity was 6 (+/- 1.4; median 6) prior to treatment and 2.4 (+/- 1.5; median 3) following nVNS; mean reduction in headache intensity was 63.3% (+/- 21.7; median 50). All 4 treated with nVNS for interictal PPPD reported no benefit. Conclusion Our study provides preliminary evidence that nVNS may provide rapid relief of vertigo and headache in acute VM, and supports further randomized, sham-controlled studies into nVNS in VM. Classification of evidence This study provides Class IV evidence that for patients with acute VM, nVNS rapidly relieves vertigo and headache.