After having done a lot of reading, I’m totally unconvinced that ‘MAV’ is caused by migraine. I suspect that there are many people walking around with fistulas, which cause a leak from the inner ear. This is well known to give you migraine and chronic vestibular problems (and all the rest), and I suspect that they are far easier to ‘acquire’ than medical dogma would suggest. Part of the problem is there has, up til now, been no test for them … the Japanese have just concluded a first trial testing the efficacy of a test for perilymph fluid in the middle ear (proof that a fistula exists). This trial also showed that fistula’s without any history of trauma are more common than ENT’s currently give credit. Interestingly, the solution to a fistula is usually medical management and time to let it heal, so a symptom management regime is still appropriate (and does not undermine what Dr S. and colleagues are doing - surgery fails 66% of the time). I still don’t like the BS that is talked about MAV though. To my mind its just a ridiculous fanciful story that a headache can cause such extreme symptoms 24/7, and one day you just wake up to find your brain is causing mayhem, whereas the day before it was completely fine?!