Scott, Victoria, and I have come up with what we hope is a very good summary of some of the most important key points that you need to know, when battling the beast that is Migraine Associated Vertigo. We hope this helps! Thanks to Dr. Steven Rauch (Professor of Otology and Laryngology, Harvard Medical School) who was kind enough to give us his input as well!
[size=110]THE TEN COMMANDMENTS OF VM[/size]
1)** WHEN YOU GET YOUR VM DIAGNOSIS, ACCEPT IT**. Once you have had thorough testing done to rule out other peripheral and central causes of vertigo and receive a diagnosis of vestibular migraine (which will likely require a migraine specialist), do NOT go from doctor to doctor trying to find another cause for your vertigo. If your MRI, ENG and other vestibular tests come back normal and you are told VM then treat VM (if your caloric shows some weakness of 30% or less, ignore it. A caloric weakness greater than 30% can still be due to migraine). You will drive yourself insane second guessing, spending countless hours on the internet, going to numerous doctors. DON’T DO IT!
2)** DIET AND LIFESTYLE MATTER**. Regarding the migraine lifestyle and diet. Do NOT ignore it! Caffeine, for example, is a big NO-NO for most migraineurs. In addition, use pain killers and nasal sprays SPARINGLY. Overuse of painkillers and nasal sprays can trigger the chronic migraine state, cause horrific rebound pain problems and/ or can render migraine medication totally ineffective. Note that food triggers appear to affect about half of migraineurs either in isolation or in combination (e.g. cheese plus wine) before triggering an attack. You will have to experiment to find and/ or rule out food triggers.
DO YOUR HOMEWORK, PART I. Read “The Migraine Brain” by Carolyn Bernstein and David Buchholz’s book “Heal your Headache”.
DO YOUR HOMEWORK, PART II. Thoroughly read the information on this forum. There is a wealth of evidence-based information here for you to digest including reports from the science literature, commentary from specialists and fact sheets from respected clinics. You will learn much from this forum. Don’t just read the posts from other members. Here’s a good place to begin: http://www.mvertigo.org/forum/viewtopic.php?f=1&t=5838
DOCS WHO TREAT MIGRAINE CAN TREAT YOU. While it is important to find a doctor to help guide you on your path to wellness and to feel that you are not alone as you navigate the world of medicines, ultimately it does not matter which doctor you visit once you have a diagnosis as long as they are willing to trial migraine medicines with you. The medicines you trial is what matters most if lifestyle modifications alone do not adequately manage your symptoms. Don’t worry about trying to see the “top” VM specialists at this point. In the end they will prescribe the same medicines that your local GP or neurologist would prescribe. Look at the list of migraine medicines listed in the 2012 National Guidelines (http://www.mvertigo.org/articles/national_guidlines2012.pdf), print it out, and take it to your doctor.
6)** MIGRAINE MANAGEMENT IS A PROJECT, NOT AN EVENT**. Medicines take TIME to work. Getting well takes TIME. Sometimes a lot of time. It may take over 3 months to have significant improvement from your medicine. You need to give a medication a fair trial. You can get better on meds; so many of us have. It may take time to find the right medicine or medicine combination. Don’t get discouraged. Some of us have trialled more than 10 medicines before we got better, some hit the jackpot on their first trial.
7)** MOOD MATTERS.** The more anxious and depressed you become, the worse VM gets. It really does. SSRIs can really help as do benzodiazepines such as Valium. Be careful with benzos though. Not only can they cause addiction but they may make vertigo worse in unusual cases when overused. However, overall, benzos are probably one of the best medicines for relieving acute VM symptoms with few side effects when used correctly. Be medicinewise.
8 ) BE GOOD TO YOURSELF. Get lots of sleep (but not too much as that can make migraine worse) and stick to a schedule of going to bed at the same time every night, eat fresh and avoid processed foods, and exercise (as much as you can aiming for 30 min daily). These things probably won’t stop all symptoms on their own but if you don’t take good care of yourself you will feel MUCH worse.
TRY DIETARY SUPPLEMENTS BUT DON’T SWALLOW EVERY ALTERNATIVE MEDICINE. Try a daily magnesium supplement. Also try vitamin B2, Co-enzyme Q10 and butterbur. but BEWARE OF ALTERNATIVE MEDICINE and implausible treatments. Almost all of it is completely ineffective, expensive and useless nonsense without any evidence. Don’t waste your time on this no matter how convincing someone sounds or how persuasive the treatment reads. Usually people report feeling better for other reasons unrelated to the alternative therapy they haven’t identified or it’s a simple short-lived placebo effect.
HORMONES MATTER. Regarding hormone fluctuation in the ladies: you will feel MUCH worse during hormone fluctuations until (and maybe even after) you get your symptoms under control. Plan accordingly. Keep track of your cycle and be extra diligent about avoiding ALL triggers during this time. As estrogen and serotonin levels drop in this time so get extra sunlight, exercise, do whatever you can do to boost serotonin and make yourself feel a little bit better. Hormone fluctuations are the worst possible MAV trigger for many of us. Be careful with making big plans during these times as you may feel at your worst. Give yourself a break.