SNRIs are effective in vestibular migraine prevention

  • Wang F & al.
  • Reg Anesth Pain Med
  • 23 Mar 2020

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) are effective and safe for the prevention of vestibular migraine (VM) and may be the best option for patients with comorbid psychiatric disorders.
  • The study also found that SNRIs are effective as prophylaxis for migraines, confirming earlier research findings.

Why this matters

  • This meta-analysis is the first to examine the efficacy of SNRIs for the treatment of VM.

Study design

  • A meta-analysis of 6 randomized controlled trials involving 418 patients.
  • Funding: Natural Science Foundation of Liaoning Province.

Key results

  • Patients receiving SNRIs vs those receiving placebo had significantly fewer migraine days (P=.04).
  • Venlafaxine vs other active drugs had a significant advantage in:
    • Decreasing the vertigo severity scores (P<.0001>
    • Emotional domain of dizziness handicap inventory (P=.03).
  • No significant difference in the rate of withdrawals between SNRIs and placebo, and between SNRIs and active drugs, because of:
    • Adverse effects: OR, 6.07 (P=.05) vs placebo; risk difference, 0.02 (P=.79) vs active drugs.
    • Any reason: OR, 2.48 (P=.13) vs placebo; OR, 0.59 (P=.31) vs active drugs.

Limitations

  • Small number of studies included.
  • Risk for bias.

Coauthored with Vijay Rathod, PhD