Vestibular migraines may be the most underappreciated cause of dizziness in the world. UC San Francisco Department of Otolaryngology – Head and Neck Surgery (UCSF OHNS)'s Jeffrey Sharon, MD, is working to change that.
Dr. Sharon is an assistant professor in the Otology, Neurotology, and Skull Base Surgery division and the director of the Balance and Falls Center in UCSF OHNS. Research from his lab has shown that vestibular migraines affect about 3% of adults in the United States. This distinct subtype of migraine causes episodic vertigo and dizziness and is one of the most common causes of dizziness. Vestibular migraine patients are often very sensitive to multiple stimuli, like lights, sounds, smells and motion, during episodes. The occurrences do not necessarily include headaches.
Despite the prevalence of vestibular migraines, there are not any studies that show which type of treatment is best, or even that treatment works.
"Many experts assume that if a medication works for migraine headaches, it should also work for migraine dizziness, but we don't really know that," said Dr. Sharon. "However, before we could do any studies evaluating different treatments, we needed a way to measure the disease. You can't study whether someone is getting better unless you have a way to quantify how bad their symptoms are."
So, Dr. Sharon set out to develop a method to measure symptom severity. With his colleagues, he developed the Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI), which is the only patient-reported outcome measure for vestibular migraines. To make the tool easy to use and accessible, Dr. Sharon and his team put the assessment on the Center's website for public use. Since then, the team has used VM-PATHI and several other methods to study specific treatments for vestibular migraine.
Dr. Sharon and his colleagues are currently conducting a randomized, clinical trial to assess whether a new injectable medication, galcanezumab, is effective and safe for treating vestibular migraines. During the study, people with vestibular migraines are randomized to receive either galcanezumab or a placebo for 3 months. The researchers check levels of dizziness on a daily basis with an automated text message system and collect VM-PATHI scores before and after treatment.
Galcanezumab works by blocking a brain chemical, called CGRP, that is released during migraines. Others have already proven that it helps with migraine headaches, and the team is eager to find out if it helps with vestibular migraines, as well.
"To date, there have been no randomized clinical trials comparing a drug to placebo for treating vestibular migraines," said Dr. Sharon. "This study will help people who suffer from dizziness due to migraines begin to find a solution."
For the pilot trial, Dr. Sharon's team is looking for adults ages 18-75 years old who are diagnosed with definite or probable vestibular migraines per Bárány Society criteria. The Balance and Falls Center is also working on studies about the effectiveness of mindfulness for vestibular migraines and predictors of vestibular treatment success.
To learn more, visit the Balance and Falls Center website.
