(PP1507) Long-Term Effects of Lifestyle Modification on Definite Vestibular Migraine

Vestibular migraine is a common cause of dizziness, but there is lack of consensus on management. This study examined the long-term effects of lifestyle modification (LM) on dizziness and headache symptoms in participants with definite vestibular migraine (DVM). Participants were divided into groups based on intervention: Prophylaxis Medication + LM, Rescue Medication + LM, or LM Only. Results indicate that lifestyle modification alone was as effective in improving symptoms of dizziness in participants with DVM as when medications were also used. Lifestyle modifications are an effective long-term treatment for dizziness in patients with DVM, but not headache. 

Summary: 

Vestibular migraine is a common cause of dizziness, but there is lack of consensus on management. Evidence suggests pharmacologic treatment is often used, but lifestyle modification is also frequently included. Recently, Roberts et al. (2021) concluded that comprehensive lifestyle modification was effective in significantly reducing dizziness and headache in participants with definite vestibular migraine (DVM). It remains unclear if these effects are long-term or if there is an advantage in combining pharmacologic intervention with lifestyle modification. 

The purpose of this study was to determine the long-term effects of lifestyle modification on reducing dizziness and headache symptoms in participants with DVM, both in isolation and in conjunction with pharmacologic treatment.

Forty-one patients with DVM were contacted and twenty-three were enrolled in the study. Participants were grouped based on intervention: Prophylaxis + Lifestyle Modification, Rescue + Lifestyle Modification, and Lifestyle Modification Only. All participants received the same lifestyle modification intervention including restful sleep, mealtime regularity, exercise, and avoidance of dietary triggers. Participants in the Prophylaxis + Lifestyle Modification group took daily prescribed medications for their symptoms. Participants in the Rescue + Lifestyle Modification group took medication as needed. Participants in the Lifestyle Modification Only group took no medications for their symptoms.  

Outcome measures included the Dizziness Handicap Inventory (DHI), Headache Disability Index (HDI), and a lifestyle questionnaire. Pre-intervention and post-intervention data were collected an average of 371 days apart in person and via Redcap, respectively. DHI and HDI data were analyzed for effects of group (Prophylaxis + Lifestyle Modification x Rescue + Lifestyle Modification x Lifestyle Modification Only), intervention (Pre x Post), and interaction. Effects of intervention factors were determined by grouping participants who had a change on a given lifestyle factor and comparing their mean DHI and HDI scores to no change using t-test. Individual participant change was found by determining the percent of participants whose post-intervention DHI and HDI scores were +18 points compared to their pre-intervention score. This was also determined for HDI using +29 points. 

Pre-intervention DHI was higher than post-intervention DHI by an average of 9.5 points regardless of group, which indicates a similar improvement in handicap related to dizziness independent of pharmacologic intervention. No difference was observed in HDI data. Participants who improved restful sleep also improved DHI, but not HDI. Finally, 30.4% of individual participants had a significantly improved post-intervention DHI, while 13% of participants had an improved post-intervention HDI. This is better than previous studies involving lifestyle modifications.

Lifestyle modification alone was as effective in improving dizziness symptoms in participants with DVM as adding medications. No improvement in headache was observed for any group. Improving restful sleep was most important to obtain improvement in dizziness. Finally, individual participants in the study had greater dizziness improvement than has been reported using other lifestyle modification interventions. Lifestyle modifications, including restful sleep, are an effective long-term treatment for symptoms of dizziness in patients with DVM, but not symptoms of headache. This is a treatment that audiologists can provide for DVM that has proven to be impactful.