Relapse without an obvious attack

Who has experienced a relapse of dizziness without an apparent attack of migraine? Any theories what this might be? Can a cold do it? I’d always assumed before I took prophylaxis that it would take a migraine attack to cause a decompensation. It’s really frustrating because I was doing pretty well and remain attack free …

For me, anything that cases stimulation of the nerves of the face/head. Too much sugar, too much dairy, brewed decaf, overdoing on exercise, too long at the computer, too much sun, as well as overdoing food triggers. Barometric pressure changes can be an issue during winter. I can feel when the nerves are overstimulated (even my lips feel like they are vibrating) and I have to be very careful for a few days while they calm down. Sometimes I take Nasonex or Allegra if it also causes sinus issues and ear fullness. Good luck. Spinninggirl (

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My experience with MAV seems to be different from most people’s, at least as far as I can tell: I don’t have well-delineated “attacks” in any way, nor do I get periods of true vertigo, I just have a constant, low-level lightheadedness and brain fogginess. Some days are better, where I only get “blips” of lightheadedness that could be classified more as very periodic unsteadiness, and some days are worse, where it’s just constant. There’s a point to this though – your question reminds me of my experiences, where there’s no obvious “attack” that brings on the worse days. I just seem to cycle through them. But my theory is that there are still triggers that are causing me to go through bad days after having good ones, it’s just more subtle maybe? Or triggers that I haven’t identified yet? Rainy days are also definite culprits for me.

I recently decompensated after a sinus attack. My doctor said that perhaps the infection that followed, irritated the nerves in my sinus cavities, which are close to my brain, and set off the MAV again.

my latest theory, is that I have some peripheral lesion which is unstable and irritating my brain. Once the migraines are under control, you are uncovering the underlying issue, imho. If you are (very?) fortunate this will heal in time and the migraines will go away. In the meantime focus on reducing the symptoms …

I looked into fistula and lesions in 2014; but in the end it was just migraine for me. I have heard a new theory about migraine: it is a brain spasm. This kind of makes sense, but its all speculation. The original train of thought is the blood vessels in the brain contract and expand, which causes the migraine.

What are your symptoms turnitaround? And what meds and dosage are you on?

Hey, John, I’m on 20mg Amitriptyline at the moment.

My logic for believing I have a lesion is this:

  1. My story all starts just over a year ago with some trauma to my ear. I’m really embarrassed to say but i tried to rid very compacted wax in my ear with slightly warm water from the shower - very stupid! Felt uncomfortable at time and within 20 minutes I started to feel dizzy! NB Doctors don’t believe this could be enough to damage inner ear (ear drum showed no sign of trauma) but perhaps I had a congenital weakness. In any case, the coincidence is very suspicious! My theory is the water may have caused the solid wax to punch the ear drum and transferred pressure punctured my inner ear. (Note how doctors also now say you should never get your ear syringed!) After this I had 4.5 weeks of severe imbalance and periodic nausea, but no auditory symptoms, which apparently cleared up, or for which I seemed to have fully compensated.
  2. Since that day, I often wake up with fluid in my ear which slightly muffles my hearing but usually clears once upright within a few seconds . It feels like the fluid is in my middle ear and the fact that it clears very quickly would kind of suggest that.
  3. Then had 5 months of no symptoms, returned to gym, went on holiday, took 4 flights, no issues except very occasionally a feeling of momentary dizziness whenever under great stress.
  4. Then, one day at the office, watching a projector, I had a sudden feeling of lightheadedness. 3 weeks later, tinnitus started. Imbalance and nausea returned. Went to see specialist. No historic hearing test to compare, but hearing test showed high frequency loss in bad ear.
  5. Imbalance and nausea subsided for weeks at a time, then returned, but soon became almost constant and migraine attacks started and worsened. Got MRI, clear.
  6. Since starting Amitriptyline, the migraines have all but gone, but I get short vertigo feelings that are combined with a feeling of fluid dripping in my ear. Imbalance generally fluctuates from almost fine to bad some days. I still get minor nausea some days, but mostly the amitriptyline keeps this at bay too.

So: Inner ear trauma caused or worsened an existing fistula which occasionally leaks into the ear. My imbalance is due to ear trying to equalise pressure. Later I get secondary hydrops which would explain the second phase and tinnitus.

I’m hopeful i’ll eventually heal but will take time. They say secondary hydrops can take a year to go once the cause has resolved. A neighbour of mine had trauma to his head and started to feel constant pressure in his ear and tinnitus. Two years later, the pressure has gone and his tinnitus has got much much better.

I note that Dr. Hain’s published conservative PLF treatment plan is exactly the same as migraine vertigo treatment. The assumption being the lesion heals, then the hydrops recede and that is that and no surgery is required. If it was just migraine all along, you are covered.

I should add, one ENT told me I may have a ‘bit of hydrops’ and told me this should improve with time. Having said all that I’ve only had the feeling of fullness once and it was intermittent and disappeared within an hour. My neuro is not yet convinced, but both agree on the Amitriptyline, I guess the only question is how much to control the symptoms? I’m still getting the occasional small sneak through migraines and periods of nausea.

Turnitaround that is an interesting conclusion. I know for a long time I thought I had something in my inner ear. In 2014 I had the fullness of my left ear, and there felt like liquid inside too. A wet dripping feeling. My MRI didn’t show anything, and I quickly abandoned the idea of any other balance disorder once the Amitriptyline cleared it at 50mg (anything below that removed some symptoms but not all), and I snapped back to normal.

If you do have a lesion, then time will tell? Your symptoms seem similar to mine; except for the sporadic attacks. Mine has always been 24/7.

I was also doing a lot of exercise before I got on the meds, and joined the gym when I started to take them. My theory for my recovery was a mixture of exercise and meds. Look up the user “beatles909” in the forum. He used nothing but exercise over a many months, with a clean diet, and regular sleeping pattern, and he beat MAV without meds. Read his success story here:

But definitely back track his posts and read his journey. Very inspiring. Its what inspired me. Also this Wikipedia article on exercise and its power on the brain is very interesting:

Also, I should add that I went to the gym last night before taking only 100mg of Amitriptyline before bed. When I woke this morning I was at 85-90% normal. I have been holding onto 90% normal for all of the day. I hit the gym again this afternoon, so I’ll see how I feel tomorrow.

Let me be clear, John, I’m almost always symptomatic, but now rarely have a significant migraine and the big migraines I used to get have been banished. My main symptoms now, whilst on ami, are persistent tinnitus, and varying levels of nausea and imbalance. The latter have improved greatly on the drug, but occasionally I can still have hours of minor nausea which is annoying. I also get feelings of eye movement discomfort from time to time and this affects my ability to work.

I do a lot of walking, running and cycling. My symptoms are only bothersome when walking, unless the nausea is really bad then no exercise is comfortable.

I’ve just met my neuro and have hearing test results that show no deterioration since the migraines began (but in my view doesn’t explain why they began in first place). She claims the fluid sensation is an artefact of the migraine condition. I’m not convinced yet. But we agreed I should up the Ami to 30mg and I’ll see how I go.

Thanks for your links and suggestion, appreciated, I’ll follow up! Agree wholeheartedly that exercise is a really good way to get and feel better.

PS John, one question, has your feeling of fluid in your ear completely disappeared now? Roughly how long did that take?

NB mine is never a feeling of ‘fullness’ just some fluid dripping into the ear or a collection of it about to drain out (which it does).

John, reviewed beatles909’s case and clearly it’s exercise that seemed to help him most … and maybe time. This got me thinking - consider another possibility: could some people with MAV have some kind of chronic BPPV … I’ve heard that dispersed crystals can give you migraine (and hydrops if they block one of the channels!) … could exercise be a way of shaking these about until they stop being loose? Could consistent exercise over time eventually free you of loose crystals in the wrong place? And the migraine trigger probably has a threshold such that you only need to resolve a certain percentage of the BPPV before the migraines start to disappear. It might also explain why Amitriptyline helps some people because as a vestibular suppressant it calms the reaction to these crystals rolling around in the wrong place and thereby increases your motion tolerance.