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Dr. Priesol's (Boston) advice to me

Went to see the great Adrian Priesol yesterday. He is a neurologist who specializes in vertigo at Mass Eye and Ear in Boston. He works with ENT Dr. Steven Rauch.

  1. Learned that I get a lot of good information from this site, from the many books I’ve read, and a few friends who’ve helped along the day. I am pretty much on the right track with management of this thing.
  2. Certain meds “reset the brain” so that you can eventually go OFF meds, and certain meds “treat the symptoms” but don’t help in the long run. I am on one of each. Amitriptyline and Klonopin. Obviously Amitriptyline is the “reset” drug.
  3. His go to drug is Nortriptyline (less side effects than Ami) but they work the same way. I may need to keep titrating up until symptoms subside. My 20mg is very low. Wait 6 weeks before titrating up.
  4. Almost all migraine drugs cause weight gain except Topamax (weight gain is an issue for me as it brings on high BP.) Topamax often has many cognitive SEs.
  5. Stress management is key - yoga, and Tai Chi especially, are good for stress management, so that when you have stress you can learn to replace the “fight or flight” response with calming alternatives.
  6. When having a flareup, go back to the elimination diet and add more meds. Figure out triggers one at a time. Eventually, with the correct meds dosage, good trigger management and many months of stability (I think he said 3 months but for me that seems too short) you should be able to get off meds. 90% of people can get off meds this way. 10% will continue to struggle until they find the right level of meds to “reset the brain.”
  7. Things get better as you age, especially women who are more affected by hormones.
  8. Take 200mg of Riboflavin 2x a day and 400mg of Magnesium 2x a day.

Thanks very much for the update and summary from your visit. Sounds like you’ve got some good support there.

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My, you certainly found a talkative one. I really wish either I saw had said one quarter of what he said to you. According to the FAQ by neurologists thread on here Nortriptyline is Dr Raunch’s first choice too or was at time of writing. It certainly seems popular. Dr Teixido offers it first to all ‘women over fifty’ I think I read. Theres been quite a lot on here had some success with it though I don’t think we’ve heard of any of them going on without it at a later date but I expect they have moved away from here before that time came around. As you say three months certainly doesnt seems long (enough) not for us chronic folk. Btw according to British television medical programmes I’ve seen Tai Chi lowers blood pressure and can double heart rate (is that good? I don’t know). Interesting though and I found it quite enjoyable.

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Just added Riboflavin and Magnesium info above.

And it was my New Patient visit so I got a full hour with him. I think of him as the most knowledgeable vertigo doc in the country, though Steven Rauch and Greg Whitman are also up there. I hear a lot about Timothy Hain but don’t know much about him.

BTW, the contractor I just hired has migraine so bad that he goes entirely blind (as in BLACK) and becomes paralyzed from the waist down. We should count our blessings.


My 2 cents is “not necessarily”. My Neurologist had several colleagues that went through med school on Topomax without any issues. And I got up to 50mg without any cognitive issues (stopped only because of insomnia, otherwise a great drug for me).

I was on 200 mg Topomax and while it reduced my symptoms, it introduced a worse symptom. I had perpetual Gurd unless I drank only water and ate very bland foods such as white bread. No meat, nothing with any oil, nothing with even the simplest spices such as black pepper, sage, etc. I was losing weight on it because I was starving, but if I ate, my esophagus was on fire from the Gurd. I stopped taking it after about a month, after I had an upper GI done only to find nothing wrong.

I’m now on Pregabalin twice a day, and Nortriptyline in the evenings. They control my sciatica, but so far nothing on the VM front.

Someone on here recently said Dr Hain is about to retire.

Your contractors migraines certainly sound horrendous. I hope for his sake they are very infrequent. Interest he ‘blacks’ out. Only only time I’ve ever lost my sight with this condition as yet I whitedout. I couldn’t see anything but white. Not sure which shocked me more. The fact I lost my sight or the fact everything went white when I’d have expected it to be black. In my case it only lasted seconds less than half a minute I’d guess and no paralysis thank goodness. That would have been really scary.