Abstract
Problem
Do migraine prophylactic medications effect the vestibular rehabilitation of individuals with Post-Traumatic Migraine Associated Dizziness (PTMAD)?
Methods
Traumatic Brain Injury (TBI) is a common cause of neurologic disorders with a reported incidence in the literature between 180 to 500 per 100000. Individuals affected by mild TBI have a diverse range of symptoms that include but are not limited to dizziness, concentration difficulty, migraine headaches, emotional lability, nausea, anosmia, sensitivity to light and sounds. Evidence of post-traumatic migraine associated dizziness (PTMAD), following mild TBI, have been described and characterized previously by our group. In this retrospective review, we looked at 90 males with blast exposure or blunt head trauma suffered in combat and a diagnosis of PTMAD who were placed on Elavil, Verapamil, or Topamax medications for migraine prophylaxis. These patients, while on these medications, actively participated in a vestibular rehabilitation program over a 6–12 week period of time. We compared those individuals at the completion of their rehabilitation to determine the effectiveness of these specific medications on resolution of symptoms and returning to work. Patients were subjected to specific objective neurovestibular tests which included computerized dynamic posturography (CDP), dynamic visual acuity (DVA), and dynamic gait index (DGI).
Results
Comparisons between drug regimens and resolution of symptoms will be discussed.
Conclusion
Although subjectively, physicians have had success in our group on PTMAD, a thorough evaluation of the best medication for this condition and its relationship to expedite recovery has not been characterized. These results will guide selection of migraine prophylactic drug therapy in PTMAD.
Significance
The significance of our study will help guide the treatment of patients with trauma related migraines and dizziness during their rehabilitation.
Support
United States Navy.
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