***Questions for Neurologist - Prof Dominik Straumann***

Hello All,

I have been in contact with the head neurologist working in Zurich University hospital and he would be happy to give his point of view on any questions you may have related to Vestibular Migraine.

Dr Straumann: http://www.neuroscience.ethz.ch/research/motor_systems/straumann/index

Please submit your questions in here. I will continually update the questions in this post and then we can submit the top 10-12 for Dr Straumann to answer.

Current Questions:

  • How do you handle other potential diseases that might be mimicking Vestibular Migraine, such as Lyme disease or CSF leaks?

  • You may use someones history of migraine to diagnose vestibular migraine, but after an initial diagnosis of VM, what would lead you to believe it could be something else? Multiple failed medicines?

  • Why is ‘chronic’ Vestibular Migraine still not clearly recognised? we see hundreds of people come through the forums with this condition and there’s probably thousands out there that are suffering unaware of these type of internet forums.

  • What do you believe is the cause of these chronic types of Vestibular Migraine? what triggers this chronic state of VM?

  • How prevalent are chronic migraine symptoms as a pose to episodic?

  • Has there been any research that connects migraine activity or vestibular dysfunction with the autonomic nervous system or autonomic dysfunction?

  • Does a history of autonomic sensitivity (fainting, low BP, BP irregularity, heart arrythmia etc) often coincide with migraine or vestibular dysfunction?

  • What are your thoughts on using migraine preventive medication, lifestyle and diet changes to treating chronic Vestibular Migraine?

  • Can you explain why many patients with Vestibular Migraine also suffer with anxiety?

  • Many sufferers of Chronic Vestibular Migraine find it extremely difficult to cope with this condition. What would you advise them is the best way to deal with this dreadful condition?

  • Do you believe migraine is currently a popular diagnosis, and if so is it at risk of being over diagnosed?

  • Many of us on this forum suffer chronic periods of migraine for weeks, months or even longer. Is ‘chronic’ the correct way to define this or is it more accurately considered an unbroken cycle of migraine?

  • Is there any evidence (or does he think) that regular exercise helps as a treatment for migraine?

  • Where female sufferers see their VM symptoms increase around menstruation or menopause, should hormonal treatments be considered and why is there so little research into the link between hormones and migraine?

  • Can migraine cause bilateral abnormalities in auditory evoked potentials, and if so, what might be the nature of such abnormalities?

  • Can migraine, or its effects, mimic trigeminal neuralgia?

  • Why does VM continue to trigger severe visual vestibular symptoms (particularly in relation to computer use, fluorescent lighting, car, bus & train travel) even when other symptoms are fairly well controlled?

  • what exactly is happening internally, to keep someone feeling dizzy 24/7 - someone who doesn’t get any ‘traditional’ crippling migraine headaches or visual auras, etc?

  • I know there are (outdated?) views on blood vessel spasms, and also an ‘irritated brainstem’ - but what exactly does this mean (e.g. if an ‘irritated brainstem’ is largely to blame, irritated how? Chemical imbalances, blood vessels, …?).

  • can vestibular migraine be related to other auto-immune disorders?

  • do you see the various migraine preventative drugs as the way forward in treating this condition? if not, what do you advise patients who have this chronic condition?

  • How long do you generally keep people on medication if it is helping with their condition?

  • Can you explain in Layman’s terms how the cerebellum & cortex are involved in causing the balance & visual problems?

@Scott / dolfnlvr / dizzielizzie - i have rephrased your questions slightly, let me know if you would like them updated,

cheers
Rich

Hey Richy,

Great questions and a coup to have another specialist happy to answer our queries. Well done. Just a couple of suggestions from me. The first one is similar to your first two, so may just be a word smithing issue.

  1. We understand that along with symptoms/history migraine is a diagnosis of exclusion. Which other conditions do you look for/how broadly do you cast the net in ruling out other conditions?

  2. Do you believe migraine is currently a popular diagnosis, and if so is it at risk of being over diagnosed?

  3. Many of us on this forum suffer chronic periods of migraine for weeks, months or even longer. Is ‘chronic’ the correct way to define this or is it more accurately considered an unbroken cycle of migraine?

Thank you!

Great questions there and well done getting him here. I would be really keen to hear his response to the autonomic stuff. Also:

Is there any evidence (or does he think) that regular exercise helps as a treatment for migraine?

Andrew

the question about exercise is a good one :smiley:

Where female sufferers see their VM symptoms increase around menstruation or menopause, should hormonal treatments be considered and why is there so little research into the link between hormones and migraine?

Can migraine cause bilateral abnormalities in auditory evoked potentials, and if so, what might be the nature of such abnormalities?

Can migraine, or its effects, mimic trigeminal neuralgia?

Why does VM continue to trigger severe visual vestibular symptoms (particularly in relation to computer use, fluorescent lighting, car, bus & train travel) even when other symptoms are fairly well controlled.
Barb

Scott - this seems to be an issue for a lot of people - there may be a better way to pose the question.

Hi Richy,
well done in arranging this!
I’d love to get Dr Straumann’s view on what exactly is happening internally, to keep someone like me feeling dizzy 24/7 - someone who doesn’t get any ‘traditional’ crippling migraine headaches or visual auras, etc?

I know there are (outdated?) views on blood vessel spasms, and also an ‘irritated brainstem’ - but what exactly does this mean (e.g. if an ‘irritated brainstem’ is largely to blame, irritated how? Chemical imbalances, blood vessels, …?).

Thanks, and well done again in setting this up!
Tony.

I would like to ask the doctor if vestibular migraine could be related to other auto-immune disorders? I also have type 1 diabetes and hypothyroidism.

Hi All,

I will put all of the questions together this weekend and then submit to Dr Straumann next week,

Cheers
Rich

Richy – a little more added on to the Q above:

It is obvious that many women get hit with migraine attacks and become highly symptomatic when their periods strike. This suggests that the trigger is a sudden change in hormone levels. Do you see any point in trying to work with a female’s hormone levels to stop the attacks?

It appears to be a lost battle because 1) a woman’s hormones are highly variable at any stage of the month 2) how would anyone know which hormones to target in the first place (see #1)? 3) Is it safe to target hormones without making things far worse? 4) Is there any evidence (expert opinion even) to suggest this is even worth following up? We have seen not one person on the mvertigo forum who successfully treated migraine with hormone supplementation. However, because this approach seems like a logical one at first glance, the internet is rife with scams using bioidentical hormones for migraine. I’d welcome your thoughts on this. :slight_smile:

I’d love there to be a question regarding the diet. Is it ok to have eggs/dairy. Are tomatoes really ok? How careful do we actually have to be?

My doctor told me not to get too carried away with the diet, as the meds were what was necessary to calm my brain down properly, the diet would just prevent unwanted worsening of symptoms…

Hi Scott,

Just to explain the background to me raising that question: the onset of my chronic MAV coincided with early menopause at 39. At the beginning docs dismissed it as either coincidence or that the stress of illness had caused a cessation of periods. Now that is officially menopause at 41, and I have finally found someone who actually knows what they are talking about (a professor at the National Hospital of Neurology in London), she regarded it as highly significant and is considering referring me for extensive tests of my hormone levels to try to fine tune HRT with the expectation that it may well help my migraine. But as you say, this is not a conventional approach and not one that has any success stories to my knowledge, but she certainly thinks it worth a shot. Which is why I wondered what another specialistmight think.

I hope it isn’t a lost battle and I am certainly willing to give anything a try. Will let you know how I get on.

N

Guys, sorry I haven’t done anything about this yet. Been feeling so rubbish lately I have not had the energy… I will do so in the next days promise

hi All,

I have updated all of the questions. We currently have around 20 which I think is a few to many. I am happy to submit them to the doctor but think somewhere in the region of 12 would be more digestible for the doctor.

I think the questions relating to Hormones / Menopause are obviously very important so should stay in there. Would like to hear your views on other questions you feel are important.

Will then submit the top 12-13,

Cheers
Rich

It would be really great to ask him about HOW LONG we should stay on meds. This is something people ask on here constantly.

Richy
Sorry, I know this is adding yet another question but is one I would love a clearer ‘picture’ of.
How the cerebellum & cortex are involved in causing the balance & visual problems, etc. we experience with Vestibular Migraine and how do the medications we take attempt to ‘fix’ those symptoms. An explanation in ‘layman’s’ terminology would be fantastic!

This explanation may cover my previous question regarding visual vertigo & possibly Tony’s as to 'what is going on in our heads?
Barb

Dear All,

The questions have been submitted. I await the Dr’s response and will let you all know as soon as that is received :slight_smile: