Flunarizine and cinnarizine in the prophylaxis of vestibular migraine and migraine-associated menière's disease: An 8-month retrospective study.

BACKGROUND: Vestibular migraine (VM) and migraine-associated Menière's disease (MAMD) are common causes of recurrent vertigo, often resulting in substantial disability and impaired quality of life. Preventive therapy is challenging, and calcium channel antagonists such as flunarizine and cinnarizine have been proposed as effective options, though comparative evidence remains limited. METHODS: This was a retrospective cohort study including 402 consecutive patients diagnosed with VM (n = 298) or MAMD (n = 104) at two vestibular specialized centers. Patients received either flunarizine (10 mg/day; n = 250) or cinnarizine (75 mg/day; n = 152) for 8 months. Efficacy was assessed through reduction in monthly vertigo attacks, subjective improvement, and changes in Dizziness Handicap Inventory (DHI) scores. RESULTS: Mean age was 49 ± 11 years, and mean disease duration was 10 ± 5 years; 46% had previously failed at least one preventive therapy. Baseline mean vertigo frequency was 1.6 ± 0.8/month and decreased to 0.2 ± 0.3/month after 8 months (p < 0.001). Overall response rate (≥ 50% reduction) was 81.6%, with flunarizine demonstrating slightly superior efficacy compared with cinnarizine (84% vs. 77%; p = 0.03). Adverse effects were generally mild and reversible, including somnolence, mild cognitive slowing, and weight gain. CONCLUSIONS: Flunarizine and cinnarizine are effective and generally well-tolerated prophylactic options for VM and MAMD, although their antidopaminergic properties should be considered in clinical decision-making. Flunarizine showed slightly higher efficacy. These findings support calcium channel antagonists as first-line therapy, particularly in patients with long-standing or treatment-resistant disease.