Migraine Associated Vertigo (MAV) – Misdiagnosed as Meniere's

Thought I would post this link on migraine and cochlear dysfunction.

http://www.hearingreview.com/insider/2008-04-17_11.asp

 

Thank you James.

 

Oh, my God!
Thank you soooo very much for writing this post...I found it to be very helpful indeed.
Burd has been most helpful to me on many occasions in the past.

Blessings,
MamaBear

 

You're welcome mamabear. I'll be sure to pass your comment on to Scott/Studio.

 

bump

 

Excellent post, Studio

 

Thank you all for the excellent posts!

This is still new to me (had my first drop attack 4/24/11 and in the ER with a non-stop drop-attack 4/26/11), was dx w/MM in May 2011 but no answers why I still feel like I'm drunk to varying degrees through the day (worse in early AM, recovers, and then gets worse again in the evening) and I end every day with a headache. MAV seems like a logical fit from what I have read here.
Will be investigating more.
Thank you SO MUCH as I have a more direction. Seeing a neorologist on Tuesday, will share this with her.

Signed - very grateful!

 

Hi Steffrz
Nice to meet you! Let us know if we can be of help.

 

Thought I'd add the quote about hearing loss here so that it doesn't get lost among posts in the Living Room.

Migraine can most certainly cause hearing loss. This is not a distinguishing factor separating MAV and MM. There is a large amount of literature out there to support this observation. Example:

This from a recent publication (2010) in Otology and Laryngology, Harvard Medical School. Author: Steven D Rauch

"Large epidemiological studies have shown that 25% to 35% of migraineurs experience episodes of dizziness or vertigo, many of which are indistinguishable from Meniere’s attacks. Animal studies have shown trigeminovascular control of cochlear blood flow, and clinical reports suggest that as many as 25% of migraineurs may experience fluctuating or progressive sensorineural hearing loss. It is virtually certain that a significant subset of ‘‘classic’’ Meniere’s disease cases are migrainous. Migraine should therefore be added to the list of putative causes of Meniere’s disease."

James

 

interesting stuff James: a good read. All this time i thought you were larry king. now i know your name.

so now how do they know if you have mm or mav. is there any indication that mav causes vestibular loss?

 

Bulldogs --

Great question on "how does one distinguish between the two?" The best way for me to answer you is to look at the evidence:

• Large epidemiologic studies have shown that 25% to 35% of migraineurs experience episodes of dizziness or vertigo, many of which are indistinguishable from Meniere’s attacks.
  
  
• The overall prevalence of migraine in the general population is 13%, and 25% of those patients (3.25% of the general population) experience dizziness or vertigo along with other migraine symptoms. Because the prevalence of Meniere’s disease in the general population has been estimated at only 0.2% to 0.5%, a patient presenting with episodic vertigo is up to 15 times more likely to have MAV than Meniere’s disease. How many practicing otolaryngologists are currently diagnosing migraine 15 times more often than Meniere’s disease? On a purely statistical basis, one would predict that 13% of patients with Meniere’s disease would also be migraineurs. In fact, the comorbidity of Meniere’s disease and migraine is much higher.
  
  
• The prevalence of migraine in patients with Meniere’s disease is 56%, and in patients with bilateral Meniere’s disease, it is 85%.

If migraine-associated vertigo is so much more common than Meniere’s disease and if the symptoms overlap so heavily, how does one differentiate them? When does a patient have simple Meniere’s disease? When do they have MAV? When do they have migrainous Meniere’s disease and when is migraine present as an unrelated health issue? Meniere’s disease is an inner ear disorder. Migraine is a neurological disorder with possible inner ear manifestations.

• There is no doubt that many patients diagnosed with ‘‘atypical Meniere’s’’ are actually migraineurs. Patients with Meniere’s disease always have associated hearing loss in one ear; migraineurs may not.
  
• Patients with simple Meniere’s disease do not have migraine headaches temporally associated with their vertigo attacks. They do not have scintillating scotomata, photophobia, or phonophobia. They rarely complain of the cognitive dysfunction (‘‘brain fog’’) that is prevalent in migraineurs.
  
• Patients with Meniere’s disease typically only feel nauseous during a vertigo attack. In contrast, migraineurs are plagued by many smoldering sensory symptoms. Even when they are not in the throes of an acute vertigo attack, they may have ‘‘rocking boat’’ dysequilibrium, nausea, motion intolerance, and brain fog.
  
• Migraineurs often admit to photophobia and/or phonophobia that accompany their acute vertigo attacks. They often have vertigo attacks in close temporal association with headache or ocular migraine.
  
• Migraine has a significant genetic component, and many migraineurs have other affected family members.
  
• Migraineurs are sensitive to diet, barometric pressure change, stress, lack of sleep, hunger or dehydration, and hormonal fluctuation.
  

Early in the assessment and management of a patient with possible Meniere’s disease, differentiating Meniere’s disease from migraine may not be all that important. The lifestyle recommendations of regular meals, sleep, and exercise and the general medical management of any other outstanding health issues benefit both conditions.

If migraine is at all a possibility, at this point in the management, it is prudent to offer patients a trial of aggressive migraine management. A 1- to 2-month trial of strict migraine diet and lifestyle is undertaken first. If this trial fails to gain adequate symptom control, patients are continued on the diet and a migraine suppressant medication is added.

Migraineurs tend to be extremely susceptible to medication side effects, so suppressants are best started at a subtherapeutic dose and increased in small increments every 2 weeks. It typically takes about 6 to 8 weeks to reach a reasonable therapeutic dose and determine if the medication is helping. Further dose adjustment may be needed, but usually there is some indication within 2 months that the treatment is on the right track. If there is no indication of symptom response to migraine therapy, then invasive treatment for Meniere’s disease can be undertaken with confidence.

J

 

James:

here is the million dollar question: if you have mav and the medicine works does it take all the symptoms away, fullness, tinitus, vertigo ect.....

i had a VRT session on Thursday and i asked the Dr. at Emory this very thing and she said that usually if hearing loss is in the low tones and you have vestibular damage the diagnosis will be mm.


had one dr. at Hopkins say if the patient presents with symptoms in both ears at same time they will typically go with the mav diagnosis. and if things don't improve they switch to the mm.

 

"If you have MAV and the medicine works does it take all the symptoms away, fullness, tinnitus, vertigo, etc..?"

My personal experience says if caught early enough and given correct diagnosis and proper treatment you reduce your risk of permanent damage.

Migraine medicine only masks the symptoms it doesn't cure you. Identifying and reducing your exposure to migraine triggers can be quite beneficial. It may reduce or eliminate your dependence upon daily migraine medication for relief of symptoms.

 

Hi SCC -- I think there's a better way to look at this rather than thinking meds simply "mask" symptoms. I don't believe this is the case. However, you are quite correct that there is no cure.

If you think of a migraineur standing in a swimming pool full of water, a person experiencing debilitating symptoms has the the water level above their nose. In other words, they're sucking in water. By avoiding migraine triggers (e.g. certain foods, sleeping properly etc) and making sure your health is otherwise OK, you effectively lower the water level in the pool and symptoms are no longer experienced. However, for some people (about 60%), these measures are not sufficient and so the next step is to take an effective migraine medication which causes you to grow taller in the pool and rise above the water line. Even if both methods are used, a "fat kid" can still occasionally jump in the pool and you take it in the face (this is synonymous with a whole host of triggers occurring at the same time).

The reality is that migraine is a genetic problem which can involve problems with calcium channels (one example) in the brain. A drug like Verapamil blocks the channels and stops the error and so the symptoms go. For others it may be a serotonin problem (probably a lack thereof) and so an SSRI is effective for MAV in these people. So it's not a mask but a treatment (sometimes with unfortunate side effects) to fix a genetic error.

J

 

I agree. It is the bucket theory. In my case identifying and reducing exposure to my triggers eliminated my need for daily migraine tabs. There is no way I can control everything within my environment so the bucket continues to overflow. Now it can take weeks or months for it to happen instead of every day. Use of a migraine abortive in those situations works great for me.

 

This is an interesting article about Vestibular Migraine from Johns Hopkins. It shows how similar the symptoms are to MM.

http://www.hopkinsmedicine.org/neurology_neurosurgery/specialty_areas/vestibular/conditions/vestibular_migraine.html

 

Excellent contributions to the thread Larrikin and So Cal. Thank you!

 

burd are u wearing body paint?

 

Thanks for the great post So Cal Cyclist, I appreciate it!
~Steff

 

Thanks for the link Socal,first time I have seen a medical site such as this actually using the term vestibular migraine.That it's Hopkins is even more impressive.