Anxiety or MAV

I have been constantly dizzy ( drunk feeling) for over a year! I have had every test know to man and they have not found anything. A few Neuro’s I saw said it could be Migraine related though I have never had a migraine in my life. It gets alot worse in grocery store and when I do ANY type of exercise I am dizzy the rest of the day. My physchiatrist thinks it is anxiety ( have struggled with a panic disorder for around 10 years), but I wish I knew which one was right Anxiety or MAV?? Thanks for listening!!!

Could be both or purely migraine related. Scott posted an article in earlier discussions called MARD (Migraine Anxiety Related Diagnosis ?). It’s really interesting. I’ve had chronic illness for over 3 years, and any chronic condition imparts anxiety as an offshoot to the sufferer. Check out the article and also consider buying the book Heal Your Headache which explains why chronic migraines can consist of ONLY dizziness and not headaches. Mine did!! That’s what led me to a neurologist… 3 years of nonstop dizziness. I’m improving now.

Wow thanks, are you taking any medication???


This was something I posted on another forum that might be useful for you to read:

Before this illness landed on my doorstep I had never experienced any really serious anxiety. Sure, I’ve had nerves before public speaking etc but the anxiety vestibular neuritis and then MAV created was a different animal altogether. When it first struck, the assault on my vestibular system was out of my control and with it a whole new type of anxiety landed on my doorstep – clinical levels. Looking back at the beginning, I can now clearly see that two things were going on. There was a purely physiological anxiety occurring of which I had no control and I was also fretting in a big way about the whole disaster and was therefore adding my own psychological anxiety to the mix. The result was total chaos and a complete meltdown. Once anxiety kicks in it can be very difficult to work out where it’s coming from, particularly if you’ve never experienced anything quite like it before at clinical levels.

So here’s a few facts:

  1. Dizziness occurs comorbidly with both migraine headache and anxiety disorders.
  2. There is increased independent comorbidity between anxiety and migraine alone.
  3. Dizziness occurs in 28-30% and vertigo in 25-26% of patients with a primary complaint of migraine; dizziness is the second most common feature of migraine disease after headache.
  4. Migraine affects 10% of the population.

Now given that I know with a great degree of certainty that an aura for me involves physiological anxiety and dizziness which precedes the head pain, and I have heard many others describe the same thing, by statistics alone, I would argue that a large number of people in the general population who experience chronic subjective dizziness do not suffer from an anxiety disorder per se but that the anxiety is rooted in migraine. I seriously wonder if these studies that report CSD have missed this completely.

I also think dizziness alone or whatever is going on in the vestibular system creating the feeling of dizziness or vertigo also triggers the fight or flight response centre in the brain whether you like it or not. These ideas have been covered thoroughly and a physiological explanation has been given in the following article:

And this diagram illustrates how migraine, dizziness and anxiety intersect.

Why are the three so tightly connected?

Fundamental to the pathophysiology of migraine is the trigeminovascular reflex.

Vestibular pathways can contribute to both central and peripheral migraine mechanisms. The reciprocal connections between the inferior, medial, and lateral vestibular nuclei and trigeminal nucleus caudalis suggest that vestibular and trigeminal information processing may be altered concurrently during migraine attacks, and that vestibular signals may directly influence trigeminovascular reflex pathways … changes in monoaminergic activity due to vestibular activation may both trigger migraine related symptoms and modulate activity in both pain related and anxiety related pathways.

In plain English: migraine, vestibular and anxiety neural pathways intersect in the brain. If one is stimulated, the others are impacted.

The assumption that the presence of anxiety automatically implies a ‘‘psychogenic’’ cause for dizziness is not valid. It is for this reason alone that this condition is misdiagnosed so often and you’ll hear stories about a doctor saying the patient is “just anxious”. Incredibly, one of the best treatments for MAV are meds from the SSRI family which also treat anxiety and may explain why they are so effective. SSRIs kill two birds with one stone if you look back up at the diagram which effectively shuts down the balance disorder.

The additive central effects of migraine, vestibular, and anxiety related circuits on perceptions of pain, vertigo, postural instability, passive coping, visual dependence, and space and motion discomfort are subject to considerable individual variations (no two people are alike).

So, while I do believe there are people out there with purely psychogenic dizziness, I don’t think it’s common.

Scott 8)

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Thanks, Scott for re-posting that! It’s so enlightening.
Jolivew - yes, I’m on medication. I started on topamax almost one week ago. I’m already getting results, though ofcourse it is slow. I’m one of the migraine sufferers who primarily gets rampant dizziness which has effectively stolen much of my life as I once knew it. It wasn’t until very recently that I got knockout headaches, nausea, etc. I mostly had the motion sickness kind of stuff with neurological symptoms “on the side”. It’s been a 3+ year dogfight that has led me to 10 doctors and 5 different misdiagnoses. My gut feeling is that I am on the right track. I am also doing physical therapy for my knotted up neck (old whiplash junk). I’ve taken Prozac successfully in the past so if topamax presents a problem, maybe I can switch off, who knows??? I remain optimistic. You’re in the right place on this forum. Let us know how you’re doing!!

Wow thanks so much Scott!!! That is so me. Scott you said that SSRI’s are good for this condition. Do you think ALL SSRI’s work? I have Already tried taking Zoloft, Lexapro, and Celxa, all I could not stand for more than 4-5 weeks. I am now on day 3 of Cymbalta and having a pretty hard time, but really want to stick it out. I always have Prozac as a backup but I read that some people do not believe that it works for this condition. What do you think???

it’s amazing how we are all so different on the medications and the side effects. they scare me so much. I’m afraid to take just about everything.

Nice to know some folks have had good results on prozac - that one scares me the least i don’t know why maybe because it’s been around for a long time???

my neuro said he hasn’t had luck with prozac on MaV so that bothers me. gosh some of you getting bad side effects with celexa and lexapro - that bothers me :frowning: what kind of side effects?

i’ve been sick for two months straight so i need to try something - i have to get out of this hole i’m in as Scott says :slight_smile:


Hi J,

— Begin quote from ____

Scott you said that SSRI’s are good for this condition. Do you think ALL SSRI’s work?

— End quote

I think that if a person will respond to an SSRI then they all have the potential to work. The question is more about finding the SSRI that a person can tolerate. But it sounds like you’ve given a few of them a really good go and maybe your migraine doesn’t respond in this way. What happens at the 4-5 week mark?

I know of cases where MAV has been sorted with Zoloft, Cipramil, Paxil, Luvox, Prozac, Effexor, Cymbalta, Lexapro and on it goes. But not everyone can handle all of these meds (like me).

Have you tried any of the tricyclics?


When this dizzy monster began back in 1992 and my doc diagnosed me with Panic Disorder (which ended up a wrong diagnois)…he put me on Prozac and it did not help me at all and i did not care for the side affects + i gained 20 pounds. I tried a few more SSRI’s after that but only for a brief period cause i just could not handle the side effects. Anti-depressants have never worked for me.


so Joe what do you take? im afraid of antidepressants myself - like all of them. i think i do have anxiety because of my dizziness but not sure its causing the dizziness.


Is the Paxil helping? Is it making you feel tired???

Paxil keeps my mood relatively stable. After VN in 2003, it has never been the same no matter how slowly I’ve come off an AD. Never makes me feel tired but at 2.5 mg (you read that right) it makes me feel really indifferent and was a libido killer so it’s not ideal. I really want off this stuff.

I was on Aropax (aka Paxil) about 15 years ago and it did NOT make me tired. Quite the opposite. I was bouncing off the walls and feeling aggro like I was on speed. Was given Prothiaden to help me sleep at night. Settled down after about 3-4 weeks.


Scott what has helped you the MOST for the dizzies??

Chris, i take a small amount of Alprazolam (Xanax). I use to be on a highe/stronger dosage but the last number of years i began making improvement so i weaned down to one pill or less a day and at it’s the weakest dosage you can purchase. I was on Verapamil and i think it helped some but i adventually weaned off it and don’t notice any difference. The anti-anxiety med’s tend to melt the motion i experience on a daily basis + this Tension/strained like feeling in my head. Believe me, after 18 years of this crap anti-anxiety med is the only med that has given me some relief. I often wonder if the Xanax helps to suppress the inner-ear nerve?


ps. along with Xanax, getting enough sleep, watching my diet and keeping the stress low has been helpful

Hi guys
A lot of you would be interested in doing cross-reading/research on the VEDA website: and also perusing the discussions on their Facebook page. Because I was originally diagnosed with Meniere’s, I was trying to get answers there as well. Many people report that they take either Lorazepam or Valium for motion sickness symptoms because it does tend to suppress the vertigo/dizziness symptoms. It only made me sleepy no matter how small the dose, so I’ve just stuck to OTC motion sickness meds like Bonine (meclizine chewables) or Boninie for Kids (cyclizine chewables). Doesn’t cure anything but it can sure take the edge off quick.