Last Updated on June 2, 2019
Once again thank you for all participating. I have collated the results of the responses to the treatment questions, with a few caveats.
Firstly, this was a voluntary survey and the respondents were not screened, or chosen in any way apart from self identifying. As I wrote about in the first post, this is interesting hypothesis generating exercise, rather than a guideline to treatment, but it does raise interesting points which are worth further exploration.
In terms of the most used treatments, the following graph shows that the top was vestibular exercises, followed by Magnesium, topiramate, Vitamin B2 and propranolol. To some degree surprising for a presumably highly medicalised group, three of the top 5 are not medications. The graph below shows these with the most tried treatments at the bottom and the least at the top, with the responders the blue part of the graph and non-responders the red. Be mindful that this is not advice on treatment but hypothesis generating.
In terms of effectiveness, I ranked these by comparing the ratio of those who found the treatment helpful versus those who did not. This always needs to be interpreted with caution, because some may not have responded because of side effects and others because the dose was not high enough or taken for long enough. I find in my practice this is one of the most common reasons why medications do not work. This needs appropriate supervision with an experienced therapist in migraine.
Secondly, I avoided putting in the triptans (and other acute migraine drugs) because I was looking for preventative therapies that worked for this population, rather than what may help abort an attack. Nevertheless, I was most surprised at the number of people who used benzodiazepines (anti-anxiety medications like Valium) and the numbers who responded to them. I therefore included those in the analysis and they came out as the most responsive. I will note however that these are generally ‘quick fix’ medications that may settle the symptoms rapidly and so may be more easily rated as effective than a true preventative. They are also addictive on the whole.
The results ranked in terms of most responders versus non-responders is below, with the highest ratio at the bottom. Once again, this is not advice on treatment but hypothesis generating.
Once again, thank you for your participation and I will try to engage further with more feedback. I am happy if you email me questions, which I will collate and answer the most popular.
(c) Dr Ron Granot 2015
Regarding the results which showed that Vestibular Rehabilitation had a good outcome. Having tried various kinds of VRT for positional vertigo and visual vertigo/imbalance after travelling in vehicles with no minor success I’d like to know what type of VRT provided the good outcome. Some doctors advise no VRT until stabilised on meds, others say general lifestyle (walking,shopping, etc.) is enough, others fast head movement is needed, etc. etc. I am confused!! Clarity on this issue would be much appreciated.
Barb
In the survey, as you know, there was no questioning about what sort of exercises worked. That may be a good follow up questionnaire. However, the basic premise of these exercises is to get the brain used to note movement, rather than staying stiff and still.
Diagnosed with Unilateral Vestibular Hypo function, VN and possible MAV. The band aid of Benzo’s has been a big help in getting me to the point where I am more physical active and less terror prone. I have tried many med’s but little to no help. The spinning is truly a form of personal torture that brings anxiety up. To spin uncontrollably and be told there is nothing that can be done for you is why many need benzo’s. I get they are addictive and use only as needed now, like when my nystagmus is making it hard for me to function. Until medicine can find a better way to deal with dormant virus’s causing issue’s as in the case of VN, many will rely on the lesser of two evils to just get by.