Can verapamil be effective in controlling vertigo and headache attacks in vestibular migraine accompanied with Meniere’s disease? A preliminary study

Abstract

Several studies have pointed to an association between migraine, vestibular migraine (VM) and Meniere’s Disease (MD) [1–7]. Though the underlying link is not clear they seem to be parts of a broad spectrum disorder [5] and can share a common genetic basis to confer susceptibility [2]. “VM/MD overlapping syndrome” diagnosis has been proposed for patients presenting with simultaneous symptoms/ signs of VM and MD [7]. Depending on clinical similarities with episodic ataxia type 2 and familial hemiplegic migraine, voltage-dependent calcium channel gene (CACNA1A) mutations have been searched in patients with VM, but could not be identified [8, 9]. Potassium channel mutations [10] and the role of aquaporins in inner ear water homeostasis [11] have been speculated in MD pathophysiology. Based on these speculations, we tried to analyze the efficacy of verapamil, a calcium channel blocker in controlling vertigo and headache attacks of patients with VM associated with MD which according to our knowledge has not been reported in the literature. The rationale for the study was our previous clinical observation on patients with migraine and MD who reported relief of the vestibular attacks after the initiation of verapamil for migraine prophylaxis. Patients fulfilling both the criteria of the International Headache Society for definite VM [12] and Classification Committee of the Bárány Society for definite MD [13] were recruited between October 2015 and April 2017, and included in the study. All procedures performed were in accordance with the ethical standards stated in the declaration of Helsinki and its later amendments. Informed consent was obtained from all of the participants. After a washout period of up to 2 weeks, during which migraine-preventive and antihistamine drugs were tapered off the patients entered a 4-week open, prospective baseline phase where they recorded their vertigo and headache attack frequency determined by attacks per month, and severity determined by visual analog scales (VAS) measured in millimeters from 0 to 100 on a diary. Oral verapamil 80 mg/day in two divided doses was initiated after the cardiology consultation that ruled out a contraindication for the use of the drug. The features of the initial and third month visit were taken into consideration. Statistical analysis was made using computer software (IBM SPSS Statistics v21.0). Wilcoxon signed rank test was used to compare preand post-treatment results. p < 0.05 was considered statistically significant. Of the 21 patients diagnosed as VM with MD, 17 patients (14 women, 3 men) were included in the study as 3 refused to take the drug and 1 had a long q–t interval on ECG. The mean age was 40.2 years (range 28–56 years). Vertigo and headache attack frequency and severity before and after 3 months of treatment are given in Fig. 1. A statistically significant regression was noted in both headache and vertigo attack frequency at the end of the third month (p = 0.01 and p = 0.02, respectively). Mean and median values for This manuscript is part of a supplement sponsored by the German Federal Ministry of Education and Research within the funding initiative for integrated research and treatment centers.