Supplementary Material for: Effect of Migraine Abortive Drugs on Benign Paroxysmal Positional Vertigo Odds - A Database Analysis

Introduction: Patients with migraine may be more susceptible to benign paroxysmal positional vertigo (BPPV) than the general population. Although the underlying pathophysiology remains uncertain, it has been postulated that recurrent vasospasms associated with migraine attacks may cause inner ear ischemia and changes in endolymph pressure. Currently, there are no specific recommendations for preventing BPPV in this vulnerable patient population. Among commonly used migraine abortive drugs, triptans, which are selective serotonin agonists, are known to be vasoconstrictive, whereas calcitonin gene-related peptide (CGRP) antagonists are not. This population-based study uses a federated electronic medical record (EMR) database to characterize the prevalence of BPPV among migraine patients and its relevance to their choice of abortive drug.

Methods: In this case-control study, EMR data from the TriNetX US Collaborative Network was queried for subjects who were seen at a participating healthcare organization for a vestibular disorder (ICD10: H81) between 2019 and 2024. Subjects must also have a concomitant, pre-existing diagnosis of migraine (G43). These patients were stratified by age (18-44, 45-64, 65+ years) and sex. The resulting cohorts were then divided into those with and without a BPPV diagnosis (H81.1). Patients with prior documented head trauma (S02, S06, S09), middle or inner ear surgery, or vitamin D deficiency (E55) were excluded. The prevalence of pre-existing triptan and CGRP antagonist use of each BPPV cohort was compared against the non-BPPV cohort of the same age and sex using Chi-square analysis.

Results: As expected, the female subject population had significantly higher prevalence of migraine (17.06% vs 7.26%, p<0.0001) than the males. Among migraine patients of all ages and sexes, triptan use was significantly more common among BPPV patients than non-BPPV patients (30.90% vs 25.35%, p<0.0001). Conversely, CGRP antagonists were more commonly used by non-BPPV patients than by BPPV patients (3.17% vs 2.45%, p=0.0005).

Conclusion: This study shows that, among patients with vestibular disorders, migraine patients with BPPV are more often exposed to triptans, and less to CGRP antagonists, than those without BPPV. Triptans may increase the prevalence of BPPV by potentiating vasoconstriction during migraine attacks, which may result in inner ear ischemia and alterations of endolymphatic pressure, while CGRP antagonists do not. Therefore, CGRP antagonists may be preferrable over triptans for preventing BPPV in migraine patients.

引言：偏头痛患者可能比普通人群更易患良性阵发性位置性眩晕（BPPV）。尽管其潜在病理生理学机制尚未明确，但推测偏头痛发作相关的反复血管痉挛可能导致内耳缺血及内淋巴压力改变。目前，针对这一易感患者群体尚无预防BPPV的具体建议。在常用的偏头痛终止发作药物中，曲坦类药物（选择性5-羟色胺激动剂）具有血管收缩性，而降钙素基因相关肽（CGRP）拮抗剂则无此特性。本基于人群的研究采用联邦电子病历（EMR）数据库，旨在描述偏头痛患者中BPPV的患病率及其与终止发作药物选择的相关性。

方法：本病例对照研究查询了TriNetX美国协作网络2019-2024年间因前庭疾病（ICD10：H81）就诊的受试者电子病历数据，受试者需同时具有既往偏头痛诊断（G43）。将这些患者按年龄（18-44岁、45-64岁、65岁以上）和性别分层，随后分为有BPPV诊断（H81.1）和无BPPV诊断两组。排除有既往头部外伤史（S02、S06、S09）、中耳或内耳手术史或维生素D缺乏症（E55）的患者。采用卡方分析比较相同年龄和性别的BPPV组与非BPPV组中既往使用曲坦类药物和CGRP拮抗剂的患病率。

结果：正如预期，女性受试者的偏头痛患病率显著高于男性（17.06% vs 7.26%，p<0.0001）。在所有年龄和性别的偏头痛患者中，BPPV患者使用曲坦类药物的比例显著高于非BPPV患者（30.90% vs 25.35%，p<0.0001）。相反，非BPPV患者使用CGRP拮抗剂的比例高于BPPV患者（3.17% vs 2.45%，p=0.0005）。

结论：本研究表明，在患有前庭疾病的患者中，合并BPPV的偏头痛患者比无BPPV的偏头痛患者更常使用曲坦类药物，而较少使用CGRP拮抗剂。曲坦类药物可能通过增强偏头痛发作时的血管收缩，导致内耳缺血及内淋巴压力改变，从而增加BPPV的患病率，而CGRP拮抗剂则无此作用。因此，对于预防偏头痛患者的BPPV，CGRP拮抗剂可能比曲坦类药物更优选。