Thought I’d share my experience, as it may be helpful for somebody hopefully. I do not claim the that the recommends below are the gold standard or that it would be suitable for everybody.
Went for an appointment today at the London Balance & Hearing Centre - I had previously seen 2 neurologists elsewhere and on this occasion I finally saw a neuro-otologist (I wont name the doctor here, but if you want the name please PM me).
Took a deep case history and the usual physical examination.
- Confirmed Vestibular Migraine and PPPD (although he said PPPD is a symptom not a diagnosis)
- Recommend couple VNG tests to check level of compensation;
- Told me to stick with Propanolol. I’m currently on 120mg, but he said many patients need it ramping up to 200mg+ to see results;
- Heavily stressed the importance of VRT. He claimed that its the only means by which your vestibular system can actually compensate; SSRI’s are simply to manage the secondary physical and psychological symptoms. Said that if vestibular system has fully compensated (as per VNG testing) then SRRI’s are required;
- Said VRT has low compliance & gets very boring for patients; urged me to “think outside the box” and do yoga, pilates, Tai Chi and swimming;
- His first go to medication is propranolol followed by Citroplam (based on clinical evidence by the Mayo Clinic);
- Told me to stick with B2 & Coq10 supplements;
- Didn’t mention magnesium or diet.
All in all, nothing really new.