Efficacy of Nortriptyline and Migraine Lifestyle Modifications in Vestibular Migraine Management

Objective: To evaluate the effectiveness of nortriptyline regimen and migraine dietary/lifestyle modifications on dizziness and stress levels in patients diagnosed with vestibular migraine (VM). Methods: A total of 35 patients diagnosed with definite VM based on the International Classification of Headache Disorders were included in this intervention study. Patients self-selected to receive either nortriptyline regimen alone (10-40 mg daily with biweekly escalation) (group A, n = 17) or migraine dietary/lifestyle modifications alone (group B, n = 18). Main outcome measures were dizziness severity and stress level measured by the visual analog scale (VAS). Results: At 4-week post-treatment, dizziness decreased from 6.0 +/- 2.5 to 4.2 +/- 3.4 (p = 0.069) in group A and from 8.7 +/- 1.5 to 3.6 +/- 3.0 (p < 0.001) in group B. VAS for stress changed from 5.5 +/- 1.3 to 5.4 +/- 2.9 (p = 0.93) and from 6.9 +/- 3.2 to 5.0 +/- 2.7 (p = 0.025) in groups A and B, respectively. The delta values of the VAS score for dizziness were 1.8 +/- 3.7 and 5.1 +/- 3.1 and the delta values of the VAS score for stress were 0.06 +/- 2.9 and 1.9 +/- 3.3 in groups A and B, respectively. Quality of life (QOL) improved in 88% patients in group A and 94% patients in group B. Conclusions: Nortriptyline, at a maximum dose of 40 mg, effectively alleviates patient symptoms, while a migraine diet and lifestyle modifications notably reduce vertiginous symptoms and stress levels in VM patients in 4 weeks. Both interventions are equally effective in ameliorating the QOL of patients. The ideal treatment for patients would likely need to include both medication and diet/lifestyle changes.