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What is the long term efficacy of betahistine dihydrochloride on the incidence of vertigo attacks in patients with Meniere’s disease, compared with placebo?
The BEMED trial is a multicentre, double blind, randomised, placebo controlled, three arm, parallel group, phase III, dose defining superiority trial conducted in 14 German tertiary referral centres
Results of this interesting study you can find HERE
Few days ago I saw the pt (45yr wom) with few attacks (three) of strong vertigo accompanied with nausea, vomiting, and pulsating headache. Attacks lasted 48hours and she felt dizzy next 5 days. She hasn’t have any auditory symptoms. She has migraine since she was 20. Exam during last two attacks relieved left-beating Ny.
Calorics show no labyrinth function at the right side
VHIT reduced bilaterally
cVEMP: absent at right side
oVEMP: absent at both sides
tonal audiometry: normal hearing
The first attack was 6yr ago and other two this year. Regarding history and her vestibular testing results, one would assume recurrent neuritis at right sides. But pulsating headache, the same one which she has during migraine attacks would favor vestiblar migraine as diagnosis. I doubt Meniere’s disease whenever the attack of vertigo lasts more than 24hour and also, she didn’t have any audiological symptoms jet. The explanation for right vestibular deficit would be ischemic insult as result of vasospasm during the migraneous attacks.