Hi all, thought I’d post this as it may help some of the members on this forum.
As you can read on my other posts, I’ve been at a stable 90% on 112.5mg Effexor + monthly Emgality shot for 12+ months now and that’s allowed me to live my life completely normally, including solo international vacations and such. As such the last 10% wasn’t a real issue, but definitely an annoyance; the residual symptoms included: 24/7 mild floaty feeling in the head, susceptibility to visual vertigo in some situations, occasional bouts of momentary but strong dizziness, visual snow syndrome (shaky vision, photosensitivity, image burn in, aftertrails, etc).
Encouraged by my earlier progress, I asked my neurologist (Dr Adelene Jann in NYC) if I could add in a third drug I’d been interested in - lamotrigine (brand name Lamictal), and she agreed. Our reasoning was based on the plausible hypothesis that my residual symptoms were more related to perpetual cortical hyperexcitability and thalamocortical dysrhythmia than outright migraine attacks. If those terms are somewhat unfamiliar, ChatGPT was pretty good at explaining them to me and how they connect to vestibular migraine. Anyway, I started 7 weeks ago, and already by the end of Week 1 I was feeling a slight difference. Lamotrigine has to be titrated very slowly, and so I didn’t really hit a target dose (100 mg) until Week 4.
Pleased to report that it works for me really well. It has eliminated all the residual symptoms I stated earlier except for one - the visual snow. Visual snow is also partially improved. Side effects are barely noticeable - maybe some mild headaches and a some mild dizziness every time I bumped the dose lasting about a week. Since it’s been working so well, I’m continuing to ramp up and hoping to reach a dose of 200mg daily. Hoping that pushing into that range can further reduce or eliminate the visual snow entirely, but I’d still be perfectly happy with lamotrigine if it didn’t.
If you are similar to me and a) have no headaches and b) have 24/7 vestibular/”weird head”/visual symptoms, talk to your neurologist and see if lamotrigine might be worth a try for you. It’s supposed to work much better for vertigo than for headaches. Can’t speak for headaches but it has definitely worked well for vestibular stuff for me. Have had zero cognitive or any persistent side effects from it. And there’s modest evidence that it’s useful for the stuff we need it for (see links below).
https://www.neurology.org/doi/10.1212/WNL.92.15_supplement.P3.9-055