MAV and BPPV

Hi, I was just wondering if there are any other people who have MAV and BPPV like I do? I’ve found having these conditions really confusing, as my MAV seems to have a positional aspect to it, so at times I’ve not been able to distinguish between them.

Try doing the epley maneuver. That is suppose to work after a few tries for BPPV. Sometimes one try is all it takes. You might need someone to help you do it though. That should determine whether your problem at the moment is BPPV or MAV.
Good luck!!!

Let me echo that, BPPV in most people is treatable and the Epley should reduce your symptoms if not rid you of the the condition entirely. You shouldn’t be putting up with long term symptoms from both of these conditions. Any ENT worth his salt should be able to do this for you if you’re not keen on doing it at home.

Good luck with that
Hx

Thanks for your replies. Yes, I have had three Epleys done over the last year. The first one seemed to have no effect at all (done by my GP). The second was done at the hospital and as I actually got a lot worse the day after, this was part of the reason I got changed to a MAV diagnosis (plus I didn’t have a positive Dix Hallpike at that time), along with the fact that I have other MAV-type symptoms like severe motion sickness, a history of very frequent migraine headaches etc. Then once I was on my migraine preventative meds I think the motion problems and the false movement sensations I had settled down a lot, and then I noticed that I was still left with spinning vertigo on lying down/standing up. The last time I saw the consultant (end Nov) I had a positive Dix Hallpike, and she did another Epley, and that really helped a lot. So I guess I do have BPPV too. My consultant gave me the impression that it wasn’t uncommon for MAV sufferers to have BPPV too, so that was why I was wondering if anyone else on here had both.
In some ways I am more sure of the BPPV than the MAV, but I don’t think it could be BPPV alone as I seem to have symptoms that can’t be explained by that. This balance stuff seems really complicated to me!

Hi Beech,

Reading your case is interesting from a clinical point of view but obviously sucks that you are the one stuck with it. The first question I would have for you is this: why are you certain that you have BPPV or have had it? It sounds like a GP may have made the dx but sometimes they do this when they don’t now what else could be the culprit and when they are not aware of MAV. BPPV should produce a very discrete pattern of “latency and fatigue” – latency when lying down on the side with the problem (about 2 to 5 seconds) and fatigue in that if you lie down on the bad side a second time after sitting upright with no vertigo for at least 60 seconds. It causes eye nystagmus that is directional and you will feel your eyes pulse in a particular direction unable to control them after the head movement – and then it dies down.

By contrast, MAV cam mimick this but it’s not nearly as violently in my own personal experience (I’ve had two BPPV attacks over the last 7 years) and the nystagmus is not the same or discrete although MAV can create some nystagmus with head movements if you are symptomatic in that way.

Have a read of this article:

Benign Paroxysmal Positional Vertigo Associated with Migraine

Note that large epidemiological studies have shown that BPPV occurs in migraineurs at a rate 3-fold higher than in any other idiopathic (unknown as in not slamming your head against a glass wall) cases.

So my advice to you on this is:

  1. Be sure you have had BPPV and even if you’re not certain you can treat yourself as I did the last time I was smashed with this using what’s called the “Modified Epley Procedure” or MEP. This method is highly effective and will clear out any loose ear rocks in some 95% of cases. See the video here:

http://mvertigo.cloudapp.net/t/self-treatment-of-bppv-modified-epley-procedure-mep/1013

  1. I’d say it’s very highly probable that you are a migraineur and so you’ll need to embark on cleaning things up and removing triggers and if that doesn’t end this you’ll have to look for a migraine med. Have a read through through the MAV Survival Guide on this.

Best … Scott 8)

Hi Scott and thanks for your advice/info. When I went to see my consultant in Nov she did a Dix Hallpike and I had really strong nystagmus. There was also a few seconds delay in lying down before the room started to spin and my eyes reacted (is that what you mean by latency or fatigue?). I was interested to see you recommending the Home Epley as I’ve been thinking about this, but the problem is that when I was worse last year, I generally found that any ‘messing about’ doing things with my head made my balance problems much worse. However, everything is much more stable now, and the last Epley really did help a lot, so maybe I am able to do this kind of stuff now.

Re MAV treatment, since last summer I have been on propranolol and pizotifen. I’m a long-time sufferer of (headache) migraines too so am already aware of my triggers (alcohol, irregular patterns of eating and sleep, avoidance of flickering lights etc). Since being on the medication my dizziness issues have improved a lot, as I’ve not had a severe attack in 4.5 months, and even my false movements and motion sickness have eventually pretty much resolved (although this happened so gradually I only recently realised how much I have got better!). However, my headache side of things hasn’t changed all that much, so I am left a bit puzzled as to whether the migraine meds are helping my MAV or not? Surely an improvement in the balance side of things should be matched by a similar improvement in headaches? (Even though the headache and balance side of things were not simultaneous.) My headaches are slightly improved, but more in terms of less severity rather than less frequency.

Hi Beech,

It sounds like you know what’s going on. Your description of what happened when you had the Dix Hallpike (who comes up with these names?) does ring of BPPV and you’re already on the migraine meds and have been working on the triggers. Why the headaches haven’t gone with the dizziness is bizarre. Can you describe what the headaches are like? One-sided or more like tension-type headaches? Throbbing?

Cheers … S

— Begin quote from “scott”

Dix Hallpike (who comes up with these names?)

— End quote

Sounds like an Olympic diving event.

I have both BPPV and MAV. When my vertigo first started, it started with an awful BPPV attack (my worst ever, actually). I had gotten up from lying down in bed, and started feeling dizzy. Within a few minutes, I was banging into the walls, fell to the floor and literally tried to grip onto the carpet for fear of falling off the earth, the room was spinning around so fast.

Over the next few months, the constant MAV dizziness started up. When I get BPPV, it’s a very sudden spinning attacks from rolling over, putting my head in a weird position (like if I look under the couch), etc. I didn’t like doing the exercises since I felt so awful when doing them. I pretty much control it myself; I can usually feel it coming on and quickly get into a better position to make it stop without the entire room starting to spin. Obviously, I have to be very careful about how I sleep, and I’ll never be going on a rollercoaster again! Whenever I go to the dentist or doctor, I tell them that I cannot lean back very far, and they are usually very accommodating.

My MAV is very different. Personally, I don’t actually get headaches; for me, it’s a constant feeling of imbalance, rocking, lightheadedness, feeling like I’m on a boat or as if the floor is falling beneath me. Instead of being triggered by my position, it’s triggered by stress, fatigue, hunger, bright lights, crowds, hormones, etc (pretty much general migraine triggers).

Anyway, that’s how they feel differently for me, hope that helps.

Hi Cassada,

Thanks for your story. In your case it appears that the first BPPV attack you endured was the “Big Bang” event that fired off MAV. When I saw Prof Halmagyi here in Sydney about 2 years ago he used BPPV as an example. He said that the people sitting in front of him with BPPV and still suffering are almost always the ones with a MAV chaser. All the others see their local GP for a manouvre if they know the Epley or the BPPV simply resolves on its own without too much fuss. For the migraineur, however, it’s a different ball park completely and spells the descent into a real hell that requires the input of a specialist.

Scott 8)

Scott,

That was interesting how you put it that a person’s first BPPV vertigo attack could very well be The Big Bang and a precuser to MAV. That is what happened to me…a small handful of Vertigo Attacks that seemed like BPPV at the time and then another Big Vertigo attack and the illness went Chronic.

Joe

Hi Joe,

I didn’t realise you’d had BPPV earlier on. But yup, it can be the trigger for sure whether it be VN, BPPV, Labyrinthitis or a good bang on the head has even done it to one member here. It must push the brain to a whole new level of sesnitivity and then it just gets locked in. Or maybe the genes become expressed once this sort of trigger hits the brain. Who knows but I wish I’d avoided VN. It was hell on earth.

I’ve been diagnosed previously with BPPV, labrynthitis and, if memory serves VN too. I assumed that as I now have the chronic migraine diagnosis that the others were misdiagnoses…?

Too confusing.

The throwing head around manouevre didn’t work, so I thought that ruled out BPPV.

Vic

Vic, you forgot to mention the multiple personality disorder they dx’d you with last year. :lol:

— Begin quote from “scott”

Vic, you forgot to mention the multiple personality disorder they dx’d you with last year. :lol:

— End quote

Are you suggesting that one of my alters is a migraineur but another has BPPV, another one had labrynthitis, yet another had VN? That would make sense… At least the one who is the axe weilding maniac has been quiet for a while :smiley:

Hey Scott,

I never received a confirmed diagnosis that i had Bppv but back in the late 1980’s and very early 90’s (before things went chronic in 1992) i began to have an occasional waking up from sleep with vertigo and puking my guts up. I had never heard of Bppv back then but now that i reflect it is possible that i might have had this. I had one Neuroligist say that he thought i might have Bppv with inner-ear dysfunction but that was about 1998. I had the epley maneurer done plus other vestibular exercises but never helps that much. If i’m not mistaken, if you have bppv you do not have imbalance/motion 24/7. The vertigo and imbalance would be sporadic, right? My rocking motion is all day 24/7.

Joe

Scott - I have one-sided headaches. Behind my left eye (but slightly upwards). Accompanied by nausea and a kind of heightening of my senses. I don’t usually get an aura, although I do occasionally (numbness in my left hand, or a visual aura). I’ve had migraines since I was about 12 or 13 (I’m 38 now…was going to write ‘nearly 40’ then, but decided 38 sounds much younger, ha ha).

Scott,

It’s so confusing though, because I am sure that it was the birth control pill that started this whole mess (I started it 2 months prior to my “big bang” BPPV attack). I’m off the pill now (36 weeks pregnant, actually), and ever since I went off of it my MAV has been so much better. The BPPV is still there and always will be, but is very controllable.

You would think that the pill would just cause MAV from the onset, not BPPV then MAV, but that’s how it turned out for me. I was also having hyperthyroidism around the time the MAV started up (thyroid levels normal now), which just adds in one more factor, so maybe I’ll never truly know what caused what and how they all correlate.

Cassada –

Is it possible that the pill triggered migraine which manifested first as a BPPV attack? Given that BPPV is so much more common in migraineurs this seems very plausible to me. There have been mechanisms postulated in how migraine might cause the release of ear rocks in the science literature. Maybe the BPPV was not necessarily the Big Bang so much as the sudden change in your hormone levels was. We’ll never know for sure but it’s good to know that the migraine activity is greatly reduced off the pill. Another plus is that you should be able to manage any further BPPV attacks very well with the MEP.

Scott 8)

Scott,

Very interesting, thanks! I’ve always wondered how they are connected, and it seems like they definitely can be. Obviously I’ll never go on the pill again, and I’m so thankful my MAV didn’t get worse with my current pregnancy (of course, I worry about how I’ll be with the hormone drop after birth, but I’ll cross that bridge when I get to it!).