Efficacy of Nortriptyline and Migraine Lifestyle Modifications in Vestibular Migraine Management

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology Pub Date : 2024-09-26 DOI:10.1111/coa.14231

Madelyn Frank, Karen Tawk, Ella J. Lee, Joshua K. Kim, Abdula Al-Seraji, Mehdi Abouzari, Hamid R. Djalilian

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Abstract

Objective

To evaluate the effectiveness of nortriptyline regimen and migraine dietary/lifestyle modifications on dizziness and stress levels in patients diagnosed with vestibular migraine (VM).

Methods

A total of 35 patients diagnosed with definite VM based on the International Classification of Headache Disorders were included in this intervention study. Patients self-selected to receive either nortriptyline regimen alone (10–40 mg daily with biweekly escalation) (group A, n = 17) or migraine dietary/lifestyle modifications alone (group B, n = 18). Main outcome measures were dizziness severity and stress level measured by the visual analog scale (VAS).

Results

At 4-week post-treatment, dizziness decreased from 6.0 ± 2.5 to 4.2 ± 3.4 (p = 0.069) in group A and from 8.7 ± 1.5 to 3.6 ± 3.0 (p < 0.001) in group B. VAS for stress changed from 5.5 ± 1.3 to 5.4 ± 2.9 (p = 0.93) and from 6.9 ± 3.2 to 5.0 ± 2.7 (p = 0.025) in groups A and B, respectively. The δ values of the VAS score for dizziness were 1.8 ± 3.7 and 5.1 ± 3.1 and the δ values of the VAS score for stress were 0.06 ± 2.9 and 1.9 ± 3.3 in groups A and B, respectively. Quality of life (QOL) improved in 88% patients in group A and 94% patients in group B.

Conclusions

Nortriptyline, at a maximum dose of 40 mg, effectively alleviates patient symptoms, while a migraine diet and lifestyle modifications notably reduce vertiginous symptoms and stress levels in VM patients in 4 weeks. Both interventions are equally effective in ameliorating the QOL of patients. The ideal treatment for patients would likely need to include both medication and diet/lifestyle changes.

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去甲替林和偏头痛生活方式调整在前庭性偏头痛治疗中的疗效。

目的评估去甲替林疗法和偏头痛饮食/生活方式调整对前庭性偏头痛（VM）患者头晕和压力水平的影响：本干预研究共纳入了35名根据国际头痛疾病分类确诊为前庭性偏头痛的患者。患者自主选择单独接受诺替普林治疗（每天10-40毫克，每两周升级一次）（A组，n = 17）或单独接受偏头痛饮食/生活方式调整治疗（B组，n = 18）。主要结果指标是头晕严重程度和压力水平，用视觉模拟量表（VAS）测量：治疗后 4 周，A 组头晕从 6.0 ± 2.5 降至 4.2 ± 3.4（p = 0.069），B 组头晕从 8.7 ± 1.5 降至 3.6 ± 3.0（p 结论：治疗后 4 周，A 组头晕从 6.0 ± 2.5 降至 4.2 ± 3.4（p = 0.069），B 组头晕从 8.7 ± 1.5 降至 3.6 ± 3.0（p = 0.069）：最大剂量为 40 毫克的去甲替林能有效缓解患者症状，而偏头痛饮食和生活方式的改变则能在 4 周内显著减轻 VM 患者的眩晕症状和压力水平。这两种干预措施在改善患者的 QOL 方面同样有效。对患者来说，理想的治疗方法可能需要同时包括药物治疗和饮食/生活方式的改变。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Otolaryngology 医学-耳鼻喉科学

CiteScore

4.00

自引率

4.80%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with: current otorhinolaryngological practice audiology, otology, balance, rhinology, larynx, voice and paediatric ORL head and neck oncology head and neck plastic and reconstructive surgery continuing medical education and ORL training The emphasis is on high quality new work in the clinical field and on fresh, original research. Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject. • Negative/null results In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.