Interesting email exchange with Dr Hain

Physicians, Specialists, Clinics & Visits 👨‍⚕️👩‍⚕️
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Hi All,

A member sent me this and said it was ok to post it. I think it’s an interesting read.

Scott 8)

Hi,

I found your name on the web and thought I would ask you a few questions. I don’t live in Chicago and I am from Omaha, Nebraska. Do you know of any neurologists there that you could recommend? I know you probably won’t be able to answer these questions but I was just wondering what you thought. I experience a constant dizziness (rocking sensation). One doctor told me it was migraines although I do not get headaches. I was researching different meds and was wondering what you thought of verapamil for this?? I want one with the least amount of side effects.

Thanks!

Dr. Hain:

Hi – you are a “rocker”.

Basically this is a poorly understood type of dizziness. Of the migraine prevention medications, venlafaxine in tiny doses seems to have the least amount of side effects. I don’t know the Omaha medical community – the VEDA organization might have some leads.
TCH

Thank you so much for your reply!

I was looking at the website you sent me and it doesn’t mention anything about migraine. Does that mean that the “rocking” is not caused by migraine but cause by Mal de Debarquement syndrome or is psychogenic? I’m having a hard time getting an answer from doctors telling me what this is…most are confused by it.

Venlafaxine is an anti-depressant right? It seems to me that an anti-depressant would cause more side effects than any other drugs and withdrawal? Do you think it would be less side effects and more beneficial than the verapamil?

Thanks.

Dr. Hain:

Migraine can do almost anything – I suppose rocking too, although I can’t think of many clinical examples. Dr. Yoon, at UCLA recently wrote a paper [note: I added the paper below for those who wish to read it - Scott] about recurrent MDDs and migraine. This is the main connection. Venlafaxine is the best migraine prevention drug right now (very low dose, to avoid the side effects).
TCH

Ok - One last question. Do you think it would be a good idea for me to take a migraine preventative? Since I probably don’t have migraine?

My dizziness didn’t start after I went on a cruise or anything so I’m thinking it is probably not MDDs. That only leaves a psychological reason? - Do you think that all of this is just “all in my head” and there is really no physical reason for my dizziness?

Dr. Hain:

I can’t treat you over the internet. All I can say is that in my patients with dizziness of unknown cause, I often do try them on different medications for dizziness – sometimes including migraine medications.

TCH

Ok. Thank you for your replies.

http://www.glycemicindex.com/sd/mdds_migraine_2008.png

http://www.glycemicindex.com/sd/mdds_migraine_2008.pdf

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Hmm that is interesting. He makes it sound like he’s not sure it is migraines. Hasn’t he diagnosed a lot of people here with mav? And I wonder why effexor? I’m curious if he has seen ppl do well with this drug?
Ashley

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well, could be he just doesn’t want to e-diagnose someone. In my opinion some forms of rocking vertigo may be due to malfunctioning in one of the vestibular nuclei in the brainstem; this is a laymans opinion but I believe this area for whatever reason becomes hyperactive and starts creating “phantom motion”. That would explain why people with this problem feel better in motion; the hyperactive area has something to “work with” and so things seem normal.

This “hyperactiveness” is probably in a sense a normal brainstate that it occurs in any person who goes out to sea and gain sealegs or just anyone who doesn’t suffer from motion-sickness. Those who are overall motionsick can’t habituate to the moving environemnt (can’t increase bloodflow = activity in the vestibular nuclei), but for some reason others may get locked into this overactive state even when motion has stopped, or even if there never were any motion to begin with (migraine). Compare this to getting “locked” into a depression from just a shorter bout of sadness. There is a problem with brain-plasticity here, but I have no idea why that is; perhaps Cha’s research will shed some light on the issue.

The question remaining is: if any of this were true, how does it fit in with the fact that some with rocking vertigo (or perhaps the majority?) don’t feel better in passive motion at all? They feel WORSE. It could be assumed that those with this issue don’t have a mismatch between expectation (“expecting” motion) and reality (the world is still). with these people it rather seems that some part of the brain is underactive, ie there is a mismatch because it can’t fit the incoming data together. It becomes like when you have a movie in which the sound appears before the matching images, but much much worse. This obviously could be attributed to migraine, but migraine is poorly understood itself so this answer is quite unsatisfying from a scientific viewpoint (though it may be very important from a patientperspective as it affects treatment).

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Scott, the link to this document doesn’t work, do you know where I can find it?