Vestibular Migraine: Management differences between General Neurology and Neuro-Otology

Abstract text (incl. figure legends and references)

Question: Patients with a diagnosis of vestibular migraine (VM) are frequently referred to Neurology. Here we assessed if the management received is similar comparing a general with a specialised clinic.

Methods: We audited clinical notes of patients seen in Neuro-Otology clinics (NO) and General Neurology clinics (GN) from the same tertiary hospital, from January 2021 to January 2022 diagnosed with VM. Demographics, treatment and outcomes were analysed with Jamovi.

Results: Of VM patients (n = 85), 22 were seen in GN, and 63 in NO. Sixty-seven (77%) were females, and sex distribution was similar. Age (median, IQR) was 48.7, (38.8-56.6) in the NO group, and 35.8 (27.3-50.8) in the GN (P=0.031). Preventives were advised in 77% in NO in comparison with 59% in GN (P=0.107) and there were no differences in the choice of preventive between groups. Most patients were on tricyclics (38.8%) followed by beta-blockers (15.3%), supplements (14.1%), candesartan (11.8%) and antiepileptics (3.5%). In the GN group, 2 patients were on pizotifen, and in the NO, one patient was on sertraline, prochlorperazine, botulinum toxin A and perimenstrual naproxen, respectively. In the NO group, 17.5% of patients were discharged, in comparison with 54.5% in the GN (P<0.001).

Conclusion: VM patients seen in NO are older, require more preventive medication and follow-up than those seen in GN. This could be due to a more complex clinical presentation, delay in diagnosis or failure of previous management. Patients would possibly benefit from an earlier referral to a clinic with expertise in VM.