Optimizing the management of patients with persistent postural perceptual dizziness and migraine

Abstract

Introduction. Dizziness and headache are among the most frequent complaints in neurological practice, which significantly reduce the quality of life of patients, so the development of effective methods of managing patients with persistent postural perceptual vertigo (PPPD) and migraine is an urgent task.Objective. To study and optimize typical management practices of patients with PPPD and migraine.Materials and methods. Twenty-two patients aged 39.3 ± 10.2 years with PPPD and migraine according to the diagnostic criteria of the Classification of Vestibular Disorders of the Barany Society were examined. During the study we used Hospital Anxiety and Depression scale, Beck Depression Inventory, State-Trait Anxiety Inventory, clinical otoneurological examination, otoneurological questionnaire, Dizziness Handicap Inventory, videonystagmography. After the diagnosis was made, the patients were prescribed a complex treatment. To relieve an acute attack of vertigo, dimenhydrinate was prescribed, as well as the combined drug cinnarizine 20 mg + dimenhydrinate 40 mg Arlevert, which in a number of studies showed high efficacy and good tolerability. One month later, the patients were examined in the dynamics.Results. Patients with PPPD had migraine without aura (54%), migraine with aura (14%), and vestibular migraine (32%). The level of anxiety was significantly higher in the group of patients with PPPD and vestibular migraine. There was moderate severity of dizziness in all groups of patients, after one month against the background of ongoing therapy severity of dizziness significantly decreased in all groups. Diagnoses “PPPD” and “vestibular migraine” were not set beforehand in any of the examined patients.Conclusions. The study showed a low level of diagnosis of PPPD and vestibular migraine. Management of patients with PPPD and migraine requires a complex approach.