Migraine management for the otolaryngologist

Objective To characterize migraine pathophysiology, presentation, and current treatment strategies, specifically in regard to vestibulocochlear manifestations of migraine. Methods Narrative review available literature. Results Migraine disorder can be described as a spectrum otologic manifestations, with vestibular now recognized fully-fledged diagnostic criteria. Otologic are theorized due, part, trigeminal innervation the inner ear structures calcitonin gene-related peptide (CGRP) expression within labyrinth. Patients experience vertigo, aural fullness, enhanced tinnitus, hearing loss without characteristic headache, leading under recognition these symptoms migraine-related. Meniere's disease, mal de débarquement syndrome, persistent postural perceptual dizziness, recurrent benign paroxysmal positional vertigo have close associations may exist on spectrum. consists two goals: halting acute attacks (abortive therapy) preventing (prophylactic therapy). Abortive medications include triptans, corticosteroids, anti-histamines, anti-emetics. Pharmacologic prophylaxis conjunction lifestyle modifications decrease frequency severity tricyclic antidepressants, calcium channel blockers, anti-epileptic medications, selective serotonin reuptake inhibitors, serotonin-norepinephrine beta-blockers, gepants, monoclonal antibodies CGRP. Promising evidence is emerging regarding ability positively treat various Conclusion manifesting primarily cochleovestibular challenging diagnose manage for practicing clinicians. vestibulopathies that closely related benefit from treatment. Lifestyle choices prophylactic key satisfactorily migrainous improve function.