Arch Otolaryngol Head Neck Surg. 2002;128:554-560.

OBJECTIVE: To investigate the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) for the treatment of patients with dizziness and major or minor psychiatric symptoms, with or without neurotologic illnesses. DESIGN: Review of 60 consecutive cases of patients with dizziness who were treated with an SSRI for at least 20 weeks during the 30-month period from July 1998 to December 2000. SETTING: Tertiary care, multidisciplinary referral center. PATIENTS: Sixty men and women, aged 13 to 81 years, with (1) psychogenic dizziness, (2) dizziness due to a neurotologic condition, as well as significant psychiatric symptoms, or (3) idiopathic dizziness. INTERVENTIONS: Open-label treatment with an SSRI titrated to 1 of 3 end points: optimal clinical benefit, intolerable adverse effects, or no therapeutic response. MAIN OUTCOME MEASURE: Change in dizziness and psychiatric symptoms measured by the 7-point, clinician-rated, Clinical Global Impressions-Improvement Scale. RESULTS: Thirty-eight (63%) of 60 patients in the intent-to-treat sample and 32 (84%) of 38 patients who completed treatment improved substantially. The response rates did not differ between patients with major psychiatric disorders and those with lesser psychiatric symptoms. Patients whose only diagnosis was a psychiatric disorder and those with coexisting peripheral vestibular conditions or migraine headaches fared better than patients with central nervous system deficits. Before being treated with an SSRI, two thirds of the study patients took meclizine hydrochloride and/or benzodiazepines, with minimal benefit. CONCLUSIONS: Treatment with SSRIs relieved dizziness in patients with major or minor psychiatric symptoms, including those with peripheral vestibular conditions and migraine headaches. Patients fared far better with SSRI treatment than with treatment with vestibular suppressants or benzodiazepines.

Comment: Migraineurs with vestibular symptoms are a challenging group to treat, especially given the labelling restrictions contraindicating triptans in patients with basilar migraine. How confident would most clinicians be in differentiating between these patient groups? DSM

I included this abstract because of the comment in the paper that those patients with migraine and dizziness did very well with SSRI treatment. This open-label study suggests that a randomized, controlled study of SSRIs in patients with migrainous vertigo may be useful. SJT