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Published on: June 2, 2014
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Resolution of Persistent Post-Stapedotomy Vertigo With Migraine Prophylactic Medication
Omid Moshtaghi1, Hossein Mahboubi, Yarah M Haidar
1*Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery †Department of Biomedical Engineering, University of California, Irvine, California.
Summary
Persistent post-stapedotomy vertigo (PSV) is rare but treatable with migraine prophylaxis. This study found that migraine-targeted treatment resolved vertigo in all patients, suggesting a migraine link.
Area of Science:
- Otolaryngology
- Neurology
- Clinical Medicine
Background:
- Persistent post-stapedotomy vertigo (PSV) is a rare complication following stapes surgery.
- Identifying the cause and effective treatment for PSV can be challenging, especially when no clear pathology is found.
Purpose of the Study:
- To describe the characteristics of persistent post-stapedotomy vertigo (PSV).
- To evaluate the efficacy of migraine prophylaxis as a treatment for PSV.
Main Methods:
- Retrospective review of patients with PSV for over 10 years at a tertiary academic hospital.
- Inclusion criteria: persistent vertigo (≥3 months) post-stapedotomy, excluding perilymph fistula, long prosthesis, or BPPV.
- Interventions included migraine dietary/lifestyle changes, Vitamin B2, magnesium, and prophylactic medications (nortriptyline, verapamil).
Main Results:
- Five patients (4 women, 1 man; average age 53) met criteria for PSV, with an incidence of 0.9%.
- Vertigo onset averaged 20 days postoperatively, with daily episodes initially.
- All patients achieved complete vertigo resolution within an average of 9 weeks of treatment.
Conclusions:
- Persistent PSV is uncommon and difficult to treat without identifiable pathology.
- Postoperative migraine triggered by stapedotomy surgery is a potential cause for this subset of patients.
- Migraine prophylaxis offers a promising treatment strategy for resolving persistent PSV.
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