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Resolution of Persistent Post-Stapedotomy Vertigo With Migraine Prophylactic Medication

Moshtaghi, Omid*; Mahboubi, Hossein*; Haidar, Yarah M.*; Sahyouni, Ronald*,†; Lin, Harrison W.*; Djalilian, Hamid R.*,†

doi: 10.1097/MAO.0000000000001596

Objective: To describe persistent post-stapedotomy vertigo (PSV) and its treatment using migraine prophylaxis.

Patients: A retrospective review of all patients with persistent PSV spanning 10 years at a tertiary academic hospital was performed. Patients who experienced persistent vertigo for a minimum of 3 months after surgery were included. Those with possible perilymph fistula, long prosthesis, and benign paroxysmal positional vertigo were excluded.

Interventions: All patients received instructions on migraine dietary and lifestyle changes and Vitamin B2 and magnesium. In addition, prophylactic treatment with nortriptyline, verapamil, or a combination thereof was started.

Main Outcome Measure: Changes in vertigo frequency was the main outcome variable. The secondary outcome variables included the time period and medications necessary to achieve symptomatic resolution.

Results: Four women and one man with an average age of 53 years were identified that met criteria for persistent PSV indicating an incidence of 0.9% at our institution. The onset of vertigo symptoms was on average 20 days postoperatively. All five patients had daily vertigo episodes and experienced complete resolution with no vertigo episodes after treatment. Symptomatic resolution was achieved over an average of 9 weeks after initiating treatments.

Conclusions: Persistent PSV beyond 3 months is a rare occurrence and its treatment can be challenging when there is no evidence of an underlying pathology. This subset of patients may be suffering from migraine, which was triggered postoperatively. Treatment with migraine prophylaxis in this cohort of patients may result in resolution of vertigo.

*Division of Neurotology and Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery

Department of Biomedical Engineering, University of California, Irvine, California

Address correspondence and reprint requests to Hamid R. Djalilian, M.D., Division of Neurotology and Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery, University of California Irvine, 19182 Jamboree Road, Otolaryngology-5386, Irvine, CA 92697; E-mail:

Presented at the American Otological Society Annual Spring Meeting; April 26–30, 2017; San Diego, CA.

Financial Disclosure: None.

The authors disclose no conflicts of interest.

Copyright © 2017 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company