(885) Surgical Trends and Severity Implications of Migraine in Patients with Meniere's Disease: A Multicenter Study

Introduction: Ménière’s disease (MD) may overlap with migraine-related symptomatology, but it is unclear how comorbid migraine influences treatment patterns over time, specifically before versus after the 2020 AAO-HNS guideline release. This study asks whether MD co-diagnosed with migraine (vs MD alone) is associated with greater 5-year utilization of treatment options and whether primary MD management patterns shifted over time.

Methods: This was a retrospective multicenter cohort study using de-identified TriNetX data (113 U.S. healthcare organizations; January 1, 2005–September 1, 2025). Adults (≥18 years) with MD were grouped by the presence vs absence of comorbid migraine and stratified into four 5-year diagnosis cohorts (20–15, 15–10, 10–5, and 5–0 years). The study measured 5-year utilization of MD treatment options (rehabilitation, medical/intratympanic therapies, and procedural/surgical care), comparing rates between MD+migraines and MD alone and examining temporal patterns around the 2020 AAO-HNS guideline.

Results: Each group had greater than 38/113 institutions repsonding. At 5-year follow-up across lookback windows, MD and migraine's showed higher rehabilitation utilization: PM&R evaluation RR=2.23 (20–15y), 1.40 (15–10y), 1.34 (10–5y), 1.28 (5–0y); PT evaluation RR=2.37, 1.41, 1.34, 1.26; neuromuscular reeducation RR=2.48, 1.62, 1.54, 1.53 (all p≤0.0002). Intratympanic injection procedures were increased in 15–10y (RR=1.43; p=0.0016), 10–5y (RR=1.79; p< 0.0001) and 5–0y (RR=1.16; p=0.021), but not 20–15y (RR=1.18; p=0.47). Acetazolamide/betahistine use was higher across cohorts (RR=2.73, 1.55, 1.36, 1.12; all p≤0.006). Canalith repositioning was higher when estimable (RR=2.33, 1.63, 1.32; p≤0.0038), with sparse 20–15y counts. Surgery differences were inconsistent across cohorts and mostly nonsignificant.

Conclusions: In MD, comorbid migraines is linked to greater long-term medical, intratympanic, and rehabilitative therapy use without sustained increases in surgery, suggesting higher ongoing symptom burden rather than worse procedural outcomes.