Mechanisms for chronic dizziness and motion intolerance?

There are three studies posted by researchers at the university of Pennsylvania (Staab, Ruckenstein, Amsterdam) who found that SSRI’s are very effective in resolving chronic dizziness and anxiety in patients. They proposed that there is an abundance of Serotonin receptors in the vestibular nucleus of the brainstem, and that is the likely site where SSRI’s decrease dizziness. They did not make the connection that migraine was the cause of the dizziness, but did mention in one of the studies that some patients had migraine headaches. Secondly, research by Smith and Darlington proposes that abrupt SSRI discontinuation in the general population can cause dizziness and motion intolerance because of the serotonin receptors present in the vestibular nucleus complex. Lastly, Drummond’s research shows that manipulating serotonin levels has a direct effect on motion sickness. It is apparent that serotonin plays an important role in processing vestibular input to the brain, and its possible that serotonin alone can probably cause dizziness without migraine involvement. I am not proposing the idea that our problems are due solely to serotonergic malfunctions, but I am curious whether our chronic symptoms are due to chronic serotonergic malfunction as a result of acute migraine. I will break it down here:

  1. Is chronic dizziness directly caused by chronically activated migraine.


  1. Is chronic dizziness started by acute migraine which alters brain chemistry, and results in low serotonin, and that is what causes the chronic dizziness. (The chronic problem can also be caused by altered calcium channels, etc… Because some patients are not helped by antidepressants).


Staab, Ruckenstein, Amsterdam.
Staab, Ruckenstein, Amsterdam.
Staab, Ruckenstein, Amsterdam. … ety.05.pdf
Smith and Darlington.

I haven’t read the links yet, but I will, and thanks for posting.
Dr. Staab, if memory serves, really believes in anxiety as the root of the dizziness. I am so tempted to believe that, as I never had any history of migraine…but I did get 2 visual auras, and that I guess is the defining YUP…sigh…

These studies particularly interest me because I have no personal or family history of migraine either. Although I have had a few mild-moderate throbbing headaches, but they did not have any associated symptoms (light sensativity, nausea, etc…). I tend to think that the patients in these studies probably had MAV without prominent migraine symptoms (like us). These studies show that migraine and anxiety/depression often have a similar mechanism. Im really interested in this research because I have had significant problems with anxiety over the past few years, and I basically had a huge panic attack the day that my MAV started. And Ive tried a calcium Chanel blocker and beta blocker with no improvements. I believe that serotonin is the problem in my case, so Im currently on Nortriptyline. But if the Nort doesnt work well, I will switch to an SSRI so Im not hitting the NE.

If you have time, I would really like to hear your opinion on this. I would also like to hear Scotts opinion here because I know he is very familiar with this research.

For anxiety, the most potent antianxiety SSRI would be Paxil. The others work too for the most part, as does the fex and cymbalta. My psychiatrist said nori not good for anxiety, but I have read posts online where people have said it helps.
I know gabapentin (neurontin) is good for anxiety as well.
I will def check out those threads tomorrow.

very interesting post and thank you for breaking it down and making it easy to read for our mav brains :smiley:

just from my family history alone, i have to say that my mom’s side lacks serotonin based on several relatives that are on SSRI’s for mild depression and anxiety. as for headaches, only my aunt and my mom recalls her great-grandmother complaining of her head hurting a lot so migraines can skip generations for sure.

personally, i am a very happy person and never thought in my lifetime would i be on a SSRI but after having this i have developed anxiety and if this is what is going to possibly help then i will try it. lexapro didn’t show much improvement so i will try effexor next, just very scared.

I will probably never know what has caused my dizziness in the last few years. I do know I have struggled with anxiety and mild depression my entire life, and out of all the mental health remedies I’ve tried (pharma and natural), the antideps worked the best. However, I will never take these things again because the side effects were not worth feeling better mentally. Even if SSRI deficiency is causing my vertigo, I would honestly rather be dizzy than ever take those pills again. Never tried Neurontin before; anyone get relief from vertigo and anxiety on this drug? What about Klonipin? Ativan is the only thing I take now PRN.

Well, after reading the majority of those links, it’s seems apparent that serotonin is the culprit in the majority of this stuff. I know my doctor prescribed Lexapro when I had my first complaint of “dizziness”…and I think that was the best choice with what she knew. It was the one with the least amount of side effects (sexual, weight gain) the new and improved celexa, so to speak. IF I were like the millions of others who just got on it and felt better I could have avoided a huge shit storm that came after…alas, I did not fare well on Lex. ANd so the story goes…speaking of which, I never posted my story, or my “success” story…gotta get on that.
Thanks for posting…I believe Dizziness is one of the main complaints that doctors see in the quick care/primary care world…they may have a migraine base, and never know…
The confusing part for someone like Dr. Hain to basically say that No, SSRI’s don’t work for MAV…then you get another respected doc Baloh, at UCLA who uses Celexa as a first line agent…

This is great info, thanks for sharing! I wonder why Nori and Ami help so much though, as they effect GABA. Also I wonder why David Buccholtz does not believe in SSRI’s and SSRNI’s helping with migraine? He’s all for Nori and Ami.

I agree with you though, I think there is a very strong link with low serotonin and dizziness.

Kelley, please do post your story!

elishat27, I am a little surprised that Ami and Nori work so well because they have a high affinity for Norepinephrine. I dont understand the role of NE in migraine, but I believe that it does play a role.

Darren, I too don’t know about the role of norepinephrine in migraine, but I DO know that Strattera (an SNRI) made a HUGE difference in my ability to concentrate through the chronic dizziness-related “fog,” which was always my worst problem.

I have no idea whether the SNRI affected my actual migraine activity. It is a little hard to judge that because what I believe to be my migraine “attacks” have always been relatively mild and varied over the years–manifesting (I believe) variously as “spells” lasting half an hour to a couple of hours, of increased dizziness, or else simply a very heightened sense of wooziness, lightheadedness, difficulty concentrating; at other times a slight one-sided headache; at other times sudden nausea that disappears completely after half an hour to a couple hours. I only had 3 visual auras, all bunched together within a few months during strong onset of perimenopause 13 years ago.

BUT–the Strattera has allowed me to consistently CONCENTRATE sufficiently well through the “fog” and dizziness. This drug made the difference between spending a good part of nearly every day in a foggy stupor wanting to just slap myself across the face in order to “wake up,” and being able to actually get things done, read the newspaper, and return to my work as a copyeditor!

Re serotonin–I have not tried any of these drugs and have never suffered from anxiety–except for the period when I was so incredibly frustrated with doctors telling me conflicting things, unable to diagnose me, and eventually treating me like a hypochondriac… that DID make me anxious and depressed, for a while!

Very interesting thread… keep the comments coming!


I was not aware that Nori and Ami affect serotonin. I really thought that they only affected GABA. They are not SSRI’s. What confuses me is all the research regarding low serotonin and it’s effect on dizziness yet Nori seems to be the go-to for most Neuro’s. Unless I am mistaken and Nori and Amni does effect serotonin? There are so many different neurotransmitters and I think that each person may differ in which neurotransmitter they are depleted in. I have a test that someone else on this site sent me that you can take and it tells you what your neurotransmitter depletion is. Mine was GABBA and serotonin. Let me know if you are interested in the test. It’s really long but it gives a lot of insight.

Nancy, I have heard that Nori is a good choice because it hits both NE and Serotonin. So you are attacking two fronts, rather than just the serotonin front with an SSRI. I am just like you with migraine, Its really hard to find actual migraine events because they are subtle. Ive had a few periods of moderate head pain, wooziness, or nausea, so I suppose those are acute migraine.

elishat27, Nori does hit Serotonin, but at relatively low levels compared to an SSRI. I would be interested in that test if you dont mind sharing, did you find the results useful for your treatment?

I wasn’t sure about that, thanks. I will send you to the test.
I have yet to find relief. The only AD that I took was Cymbalta and while it did help it didn’t help enough. I took it for 8 weeks. Yet it does not work on GABA and that is where I am so deficient. Nori is my next option which is why i am so interested in it.

This is a confusing “beast” isn’t it? Nobody’s MAV is identical to anyone else’s and therefore the treatment or treatments that work will depend on each individual’s specific chemical and biological “issues.”

Barometric changes bother some of us but not others, eating certain foods is a problem for some but not others, etc.

The meds that work for someone might give clues as to what’s going on, but it looks like they really still don’t know a lot about what’s going on inside our migraine brains (and vestibular systems) when we experience these various manifestations of the dizzies.

They’ve come a long way, but there’s room for LOTS of improvement in understanding and treatment of migraine, especially MAV.

Good points maryalice, I agree. The more time goes on, the more I believe that the 24/7 symptoms we experience are a result of the #2 option that I listed in the first post. I have heard that Dr. Surinthiran believes that acute migraine damages the nerves between the ear and brain, and the brain now doesnt trust the signals from the vestibular system, eyes, feet, etc… I believe that medications correct the damage caused by migraine. This is just my tentative theory anyway, it really helps me understand whats going on in my brain.

— Begin quote from “ichbindarren”

Good points maryalice, I agree. The more time goes on, the more I believe that the 24/7 symptoms we experience are a result of the #2 option that I listed in the first post. I have heard that Dr. Surinthiran believes that acute migraine damages the nerves between the ear and brain, and the brain now doesnt trust the signals from the vestibular system, eyes, feet, etc… I believe that medications correct the damage caused by migraine. This is just my tentative theory anyway, it really helps me understand whats going on in my brain.

— End quote

Very well said. I totally agree with this theory and it makes so much sense. I hope you are right that meds help as i haven’t personally found a med to really help. I did start Nori 3 days ago though. I have high hopes for it. Isn’t that what you are taking? How long have you been on it and how are you feeling?

This theory makes the most sense to me. I believe that some cases are fairly complicated with both chronic migraine plus the underlying damage caused by migraine (#2 option in my original post). These people experience chronic dizziness with frequent acute migraine features.

I have been on 10mg Nori for 12 days, it has already started helping. I just upped my dose to 20mg. Only side effect has been dry mouth.

That’s wonderful that Nori is helping you! I up my dose to 20mg’s after 7 days. That gives me so much hope!

Hi Elisha,

So your up to 20mg of Nort now? Im glad you decided to try it. I was under the impression that the tricylic (spelling?) anti’s hit all 3. I thought thats where the TRI came from, serotonin, NE, and Gaba… guess I was wrong for assuming. Just made sense.

I would like that test to, if you dont mind.

Any SE of the Nort? I find that it makes me feel like im on a boat. I already have been feeling that way, but after I take it, It intensifies it. Haven’t gained any weight, actually lost almost a pound. I have been careful. :slight_smile:


Hey Kristina,
I always feel like I’m on a boat and I’m ready to get off! I’m so sorry it’s adding that symptom. I would def. stay on it though. That’s been one of my biggest problems, I never stay on any meds for long bc of SE.
Yes, my Neuro wants me to up from 10 to 20 within a week and then 30 the next week. She said this is how she always does it and it’s effective for most of her patients. I’m going to go for it since so far so good.
The weigh gain worries me too. I’ve actually lost 20 lbs since I got this last spring and don’t want to gain it back!

I will send you that quiz. Remember it’s just something a friend of mine found on the internet but it’s pretty cool.