Psychological Analysis On Patients With Peripheral Vertigo And Prophylactic Therapy Of Migrainous Vertigo

Objective: 1) To investigate the audiovestibular dysfunctions in cases of migraine; 2) to explore whether patients with different peripheral vestibular diseases exhibit different ratio of anxiety and depression, and analyze the possible causes; 3) to evaluate the efficacy and safety of flunarizine in patients with migrainous vertigo(MV) as a prophylactic medication. Methods: 1) This was a retrospective study involving 321 cases of migraine, with or without audiovestibular dysfunctions such as vertigo.tinnitus and hearing loss, who were divided into 2 groups: patients with vertigo and those without. All patients with auditory symptoms underwent a detailed otological and neuro-oto-logical examination followed by audiological investigation including pure tone audiometry and auditory brainstem-evoked responses and tinnitus matching check; and All patients with vertigo underwent vestibular function test; 2) 129 patients with four peripheral vestibular diseases(benign paroxysmal positional vertigo(BPPV) n=49, migrainous vertigo(MV) n=37 Menière’s disease(MD) n=28, were investigated. All patients underwent structured neurological and neuro-oto-logical testing. SAS(Self-rating anxiety scale) and SDS(Self-rating depression scale) were used to evaluate comorbid anxiety and depression; 3) This randomized control trial was undertaken in patients with definite MV when compared to non-specific vestibular treatment of betahistine. Behavior changes were advocated to all the patients to avoide certain foods and beverages, as well as changes in lifestyle and habits. Patients in arm A received 10 mg flunarizine daily along with betahistine 12 mg Tid during episodes, and arm B received only betahistine during episodes. Frequency. duration and intensity of vertiginous episodes and the main side-effects were noted at the start of the study and at the end of 3 months. Results: 1) 25.5%(82/ 321) patients had vertigo. 7.5%(24/321) patients had tinnitus, 2.8%(9/321) patients reported hearing loss, 8.4%(27/321) patients had documented hearing loss on pure tone audiometry. 9.0%(29/321) patients’ auditory brainstem-evoked responses(ABR) showed some abnormalities in the form of prolonged absolute latency or prolonged interwave peak latencies or both. There were significant statistical differences between patients with or without vertigo on tinnitus and hearing loss; 2) 129 patients were divided into two groups on the vestibular function, and the score of SAS and SDS between the two group of normal vestibular function and abnormal vestibular function was not significantly different(P>0.05).In the four groups of different diseases, patients with MV and MD showed significantly higher prevalence of anxiety(MV=45.9% MD=50%) and depression(MV=27% MD=28.6%) than patients with VN and BPPV(P<0.05); 3) A total of 23 patients who were diagnosed with definitive migrainous vertigo completed the study of 3 months duration; frequency. duration and intensity of vertiginous episodes showed a significan improvement between them before and after treatments(P<0.05), analysis of the frequency. duration and intensity between arm A and arm B, frequency improved to a significant degree(P=0.010<0.05), the duration and intensity of vertigo between the two groups did not improve to a significant degree(P>0.05). The main side effects were weight gain and somnolence and this was not significantly different between the two groups. Severe adverse events were not found. Conclusion: 1) the patients of migraine with vertigo are more likely to have cochleovestibular affection. This study is another step toward understanding audiovestibular changes in patients with migraine. This has helped us to know the effects of migraine on both cochlear and vestibular apparatus, so that a detailed diagnostic evaluation can be undertaken in patients with migraine; 2) High anxiety/depression scores are not a result of vestibular deficits or dysfunction. Patients with Menière’s disease and migrainous vertigo showed the highest anxiety/depression scores. The possible causes for theses findings might be found in the different clinical symptom etiology of the four disease, and the patients’ ability to control or prevent the next vertigo attrack. As a consequence, psychometric testing and an interdisciplinary therapy should be proceeded in cases with complex and intractable vertigo courses, especially in patients with MV and MD; 3) Flunarizine is safe and effective for the prophylaxis treatment of MV.