title: Evaluation of the efficacy of caffeine cessation, nortriptyline, and topiramate therapy in vestibular migraine and complex dizziness of unknown etiology.
abstract: OBJECTIVE
  The aim of this study was to evaluate the efficacy of a therapeutic pathway for vestibular migraine (VM) and complex dizziness of undetermined etiology (CDUE) with caffeine cessation and pharmacotherapy.
  
  
  METHODS
  This study is a retrospective chart review.
  
  
  METHODS
  Patients were recommended to stop intake of caffeine and other putative migraine-triggering agents. Pharmacotherapy was initiated with nortriptyline or topiramate if symptoms persisted despite diet modification.
  
  
  METHODS
  Self-reported dizziness is the main outcome measure.
  
  
  RESULTS
  Vestibular migraine and CDUE were considered contributing factors to dizziness in 34 and 10, respectively, of 156 patients. Fourteen percent of patients reported improvement in symptoms upon caffeine cessation, whereas 46% of patients reported a reduction in dizziness after nortriptyline therapy (P = .007). Topiramate reduced symptoms in 25% of patients. In total, 75% of VM patients and 56% of patients with CDUE received sufficient benefit from this therapeutic pathway to not progress to other treatments.
  
  
  CONCLUSIONS
  Vestibular migraine and CDUE can be treated effectively with a therapeutic pathway consisting of caffeine cessation followed by pharmacotherapy.
authors.affiliation: Saint Louis University School of Medicine, St. Louis, MO, USA. mikuleca@slu.edu
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Mikulec
authors.forename: Farhoud
authors.initials: F
authors.lastname: Faraji
authors.forename: Laurence J
authors.initials: LJ
authors.lastname: Kinsella
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002110:Caffeine / Q000008:administration & dosage*; D004244:Dizziness / Q000188:drug therapy*; D005260:Female; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D009661:Nortriptyline / Q000627:therapeutic use; D012189:Retrospective Studies; D000077236:Topiramate; D016896:Treatment Outcome
chemical_list: D018759:Adrenergic Uptake Inhibitors; D018696:Neuroprotective Agents; D000077236:Topiramate; D005632:Fructose; D002110:Caffeine; D009661:Nortriptyline