Autonomic related vertigo

I saw an article on autonomic dysfunction and vertigo and wondered if anyone else on the forum has looked into this connection. I have the full text to the article, but I don’t think I can post it because of copyright laws (?). Anyway, here is the link to the abstract:

Laryngoscope. 113(10):1658-1671, October 2003.
Pappas, Dennis G. Jr., MD … 28!8091!-1

Basically, this researcher was looking into how many people with vertigo also had other autonomic dysfunctions such as low blood pressure conditions, mitral valve prolapse, chronic fatigue, frequent headaches, etc. He found that the vertigo in these patients improved if they were treated with the typical treatment for low blood pressure conditions (including fluid loading, high salt diets, and possibly medications). In other places, I’ve seen migraine headaches included as part of “autonomic dysfunction” as well.

Anyway, I have previously had chronic fatigue syndrome and have mitral valve prolapse and a low blood pressure condition (neurally mediated hypotension) as well as the vertigo. So, it was really interesting to me to find an article that tied them all together. I’ve recently been diagnosed with MAV and positional vertigo and am currently trying migraine meds and vestibular rehab, but I’m also going to show this article to my doctors as well.

I just thought I’d pass it along.


Thank you for the article: I get very lightheaded at times, and I do think there’s a component of autonomic dysfunction. I recently met someone who treats herself with sudafed ( a decongestant that raises blood pressure and heart rate) when she has a dizzy day, and it works for her. I also met someone who was tested by cardiology, and fainted on the tilt table, and they prescribed paxil–a SSRI anti-depressant. I did talk to the cardiologist about this, and he told me that it works, likely through the neurotransmitters.
Thanks again for the article.

I’ve also been reading that just drinking water regularly can keep your blood pressure up. I’ll paste an article about it below.

I’m in a bit of a tough spot right now. I just stopped topamax for my migraines/vertigo because of the side effects. My doctor wants to try elavil or cymbalta next, but I know that they can lower blood pressure. If this vertigo is mainly migraine related, then hopefully the medicine would help, but if there is an autonomic component to it, then lowering my blood pressure might make things worse. I guess I’ll just have to try it to see what happens.

Anyway, here’s the article about the water:

BERLIN, GERMANY. Orthostatic hypotension (low blood pressure when in the upright position) is a common complication of a failure of the autonomic nervous system. A team of American and German researchers now report that drinking water is an effective way of raising the blood pressure in individuals suffering from orthostatic hypotension brought on by autonomic failure. Their experiment involved 19 patients with severe hypotension and 11 controls. Participants were seated in a chair with their feet on the floor. Blood pressure and heart rate were measured with an automated brachial blood pressure cuff. After 30 minutes of baseline recording each participant drank 480 ml of tap water. About 35 minutes after drinking the water the systolic blood pressure had increased by an average of 11 mm Hg (millimeter of mercury) in both healthy controls and autonomic failure patients. The researchers also observed a significant increase in the blood level of norepinephrine in the healthy individuals about 30 minutes after drinking the water. They conclude that drinking water can provide a rapid relief of symptoms due to orthostatic hypotension in autonomic failure patients. They warn though that drinking water can result in dangerously high blood pressure in patients lying down (supine position). They also conclude that water should be considered to be an active substance rather than a placebo when blood pressure is involved.
Jordan, Jens, et al. A potent pressor response elicited by drinking water. The Lancet, Vol. 353, February 27, 1999, p. 723 (research letter)

I have Orthostatic hypotension. I was told by the doctor who diagnosed me with ‘BPPV’ after my first ever bout of vertigo years ago. More recently at a balance reassessment when I stood from sitting in the doctor’s surgery the machine struggled to find a reading at all. At one point the😀 doctor actually joked that I must be dead! The machine eventually proved my BP drops like a stone.

Don’t see how knowing I have OH helps with MAV though. Not a clue.

Get your cortisol levels tested Helen… I’d be interested. Plus, if it is low (low ‘normal’ counts) then this impairs blood sugar control. With high blood sugar you’ll have low sodium and therefore lower blood pressure… which in turn traps you in fight or flight as it increases adrenaline to pump the heart faster.

I am pretty much a pin cushion as it is :rofl: still I could ask. Have already had to have (docs orders) two full bloods and an ECG this year already. Not to mention the Covid fiasco. I’ve nearly as many pills in the house as my local pharmacy now.

Don’t know if this scuppers a theory but as of last count (last month) I have low blood sugar, 34 to be exact and low sodium 132 and my normal BP is within range. It just drops dramatically in Orthostatic Hypotension scenario. Last time it dropped to 90/40. And :crossed_fingers:not to jinx anything! so far (we are talking 18 years guaranteed for sure) it hasn’t caused me to faint. The link to MAV? Who knows?

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It fits perfectly. Hypoglycaemia and low sodium levels is what I’d expect to see.

Hyperglycaemia would have been the state pre-MAV and now you will bounce around with poor control. Waking in the middle of the night with hypo symptoms - sweating / racing heart or you feel like eating makes you feel better.

You also might experience postprandial hypotension as well as orthostatic?

Not noticed postprandial hypotension but I can check my own BP anytime.
No racing heart. My pulse is usually 51 bpm. But then I’m on Propranolol.
Don’t wake up hypo either. And I don’t sweat but then again Propranolol could be stopping that. I do exp hot flushes that can occur anytime and that’s been going on decades just like Granny did (which is an indicator)
But I’ll ask the question and see what He says. Am due to Speak to him next week.

Oh exactly why do I want to get my cortisol level checked? I can hardly say ‘cos Andy wants to know’:grin:

Checking for adrenal dysfunction is it?

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Well I’d prefer if you name dropped me lol
I got mine checked 2 years ago and I never asked for it. They did everything and a fasting morning cortisol test was one of them. A 24hr panel is better but they won’t do it on the NHS.

Personally I’m shocked that anyone with a chronic illness hasn’t had cortisol levels checked.

You can start mentioning adrenals but they might recoil and ask you to step away from the internet lol They only see cortisol important to check for when you are splayed out on the floor and are clearly suffering from Addisons. MAV isn’t that but I believe it is worth checking even if a doctor doesn’t.

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Can anything be done to correct it if it’s outside normal range?
Or is this pure academic interest.

Oh my fame goes before me at the Surgery. I’m known as ‘Mrs X what reads’.

Actually this current Doc is totally at ease with that. It they will all have to come around to it eventually. Makes no sense otherwise. They increasingly want us to look after our own health. We’d had to take our own BP readings to the Surgery for about 10 years now expects to keep log and understand them then next minute the doubters who don’t like people checking medical stuff on the internet expect to be able to pull the wool over our eyes when it suits them. Doesn’t compute.

Perhaps I’m rather hoping The Doc will say no to the cortisol test. Really don’t fancy being pumped full of steroids first not after the way I reacted to a couple of doses of Beconase steroid nasal spray earlier this week for hay fever.

It’s only a blood draw :drop_of_blood:
I’d find it interesting as it’s another data point.
Do you have the Patient Access app?

Sounds daft answer but I think so. I think that’s what I use for ordering repeat prescriptions. Used to use it to book appointments and to email queries to my own Doc, the latter two long since withdrawn. Far too successful I suspect at giving patients access to doctors and we certainly can’t have that going on! When I set it up several years back I declined access to my own medical records. Not really sure why I did that. Maybe I thought such browsing bit - er - unhealthy😁. It was before I hit this forum for sure.

Why do you ask?

I asked because many people I know don’t and I do and did set up medical records so I can tap on my phone and look at the graphed data of tests done over time.

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