Prospective cohort study of the impact of preventive migraine treatment on vestibular function and symptoms: The SPIRAL study
Abstract
BACKGROUND
Vestibular symptoms are common in migraine and contribute substantially to disability, even in the absence of a vestibular migraine diagnosis. Whether improvements in dizziness-related disability during preventive treatment are paralleled by measurable changes in vestibular function remains unclear.
METHODS
We conducted a prospective cohort study at a tertiary headache center including 59 patients with migraine and vestibular symptoms who initiated preventive therapy. Clinical outcomes (monthly headache days [MHDs], Headache Impact Test [HIT-6], Dizziness Handicap Inventory [DHI]) and vestibular function (video head impulse test [vHIT], bedside vestibular tests) were assessed at baseline and 3 months. The primary endpoint was the change in DHI and its correlation with vHIT parameters.
RESULTS
Participants were predominantly women (98 %, mean age 36.3 years), with 54 % chronic migraine and 66 % fulfilling criteria for vestibular migraine. Preventive therapy significantly reduced median MHDs (from 15.0 at baseline to 4.0 at 3 months, p < 0.001), HIT-6 scores (67.0-60.0, p < 0.001), and the prevalence of dizziness (75-46 %, p < 0.001) and vertigo (49-24 %, p < 0.001). Median DHI decreased modestly (38.0-32.0, median change -6.0, p < 0.001), with the largest improvement in the emotional domain. While average vHIT gains showed only minimal reductions, a decrease in vHIT asymmetry correlated with DHI improvement (r = 0.33, p = 0.010).
CONCLUSIONS
Preventive migraine…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 59 participants or records.
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