Vestibular Migraine: Evidence, Updates, and Challenges

PROGRAM DESCRIPTION: This expert lecture will provide an evidence based overview of vestibular migraine. The last 5 years have seen numerous developments which are not widely known. These include development and validation of a disease specific patient reported outcome measure (VM-PATHI: Vestibular Migraine Patient Assessment Tool and Handicap Inventory), and several clinical trials investigating both acute and prophylactic medications for the treatment of vestibular migraine. This includes the lead presenter's recently finished placebo controlled RCT looking at anti-CGRP monoclonal antibodies for vestibular migraine. In addition, we will present an easy to follow approach to the diagnosis and treatment of these patients. We also wish to highlight several non-pharmacologic options for treatment, including a prospective trial demonstrating the efficacy of mindfulness based stress reduction (MBSR). By its nature, vestibular migraine is a multidisciplinary disease, so experts will include both a neurotologist (Dr. Sharon) and an oto-neurologist (Dr. Steenerson)- to ensure that both neurology and OHNS viewpoints are represented. We will also cover results of several key trials from around the world, including the PROVEMIG trial in Germany that investigated metoprolol as a prophylactic agent, and a multicenter study of rizatriptan as an abortive agent. Both speakers have extensive experience with vestibular migraine, and we will share clinical pearls and educational materials to help audience members effectively treat these very common patients. An estimated 80% of vestibular migraine patients respond to treatment, and we hope to empower attendees to feel comfortable treating this population if they so choose.

OUTCOME OBJECTIVE 1: Learn how to use VM-PATHI (Vestibular Migraine Patient Assessment Tool and Handicap Inventory) to measure disease severity in vestibular migraine.

OUTCOME OBJECTIVE 2: Understand the results of the INVESTMENT trial, showing the efficacy of anti-CGRP antibodies in the treatment of vestibular migraine.

OUTCOME OBJECTIVE 3: Develop a toolbox of evidence based approached for the diagnosis and treatment of vestibular migraine.

BACKGROUND STATEMENT: Vestibular migraine is likely the most common cause of dizziness in the world. At a minimum, every general ENT and every Neurotologist should be familiar with it, and diagnosis. However, a growing number of ENTs wish to have the tools necessary to manage vestibular migraine.

Comprehensive Otolaryngology Track Statement :