Update on my Betahistine 'trial'

I posted a while back to report on my suspicions that coming off Betahistine (Serc) on the advice of my Neurotologist coincided with my latest horrid bout of the dizzies (Serc was prescribed over a year ago for wrongly diagnosed Menieres - but it seemed to work!, but I stopped it a month ago when MAV was postively confirmed).

Since this was one of the worst bouts I’ve had, I decided to restart the Serc last week as it couldn’t do any harm, and it had appeared to have a fantastic ‘placebo’ effect for nearly a year.

Well, one week after resuming the Serc the 24/7 dizziness has more or less vanished :? , despite eating too much chocolate and the odd glass of white wine. I’m still a bit vertiginous (if that’s a word) when out and about. I’ve also taken piriton 2 -3 times as I’ve been a bit hayfeverish so that may have helped I suppose.

Had a prebooked appt with my GP today so I went along, told him I felt better this week and wasn’t it strange re. the Serc. He’s about 110, really sweet and old fashioned, not much clue re. why I feel better. He gave me a prescription for a triptan wafer to try when my next attack starts and recommended the following regime: porridge for breakfast followed by a boiled egg, toast and marmalade. Lots of long walks in the country. And the best bit … 2 squares of good quality plain dark chocolate a day! :smiley:

Don’t know whether to laugh or cry…

(a bit less)Dizzy Izzy

Hello Izzy,

Interesting post. I used to take Serc when all this vertigo stuff started over three years ago. I stopped because I figured I did not have Menieres. Looking back, there were days when I felt it was working, but I wasn’t sure because my balance was a lot worse back then. I also had no idea what Mav was and what the word “triggers” meant. I wonder if going back on Serc could get me over the last hump of balance issues that I have now, but it defies everything I have read about Migraine. A PT told me that long term use of Serc can be damaging to the balance nerve but I havn’t heard of that anywhere else. Have you ever heard of this before?


Hi Steve

I mentioned the Serc thing a couple of weeks ago in a nother thread (before I’d restarted it) and Brenda posted this reply on April 4th:

*An audilogist took me off Serc because she said it makes migraine worse. I don’t know on what evidence she based that, maybe from anecdotal evidence of her patients, I’m not sure. She seemed to know her stuff though and was the first one of all the specialists I was seeing to come up with a diagnosis of MAV. Anyway, I wasn’t bothered about going off it because it did nothing for my dizziness. I’ve known of a few people who have taken Serc for MAV and I’ve always wondered if that audilologist had it right. She was so on the ball and so clued up that she impressed me and so I think I’ve tended to go along with her viewpoint. I did try at one point to research the subject but never came up with anything conclusive.

So that’s 2 people now, an audiologist and a physio! I’m sure I read something on Hain’s website about Serc and MAV, but can’t find it.

2 other observations:

  1. As you know, Serc is controversial in that many believe there’s no evidence it’s better than placebo even for Meniere’s
  2. Many believe Meniere’s is related to Migraine/type of Migraine anyway
  3. If you google betahistine and migraine together - there’s nothing reported anywhere as far as I can see saying it makes it worse. But there’s not much full stop, other than people on forums asking the same question!

Hope this helps (probably not!). Also, I’m probably speaking too soon and will get dizzy again tomorrow :lol:

My deep down belief in all of this is that if it works it’s all placebo anyway. It’s weird that everyone on this board seems really similar in their symptoms but REALLY different in their reactions to medications.


Dizzy Izzy


I just saw Dr. Haine’s associate last week and was perscribed betahistine. I am still looking for somebody that can fill it locally so I am still waiting to start taking it. In the mean time I have done a little bit of research and found that they have been using it for a long time around the world for meniere’s. Depending on what country the website was based from I would get different info regarding how well it works. Of course, if the site was base it the US, then the info was regarded as contreversial and no formal study had been run showing any conclusive proof. I read the pdf document from the FDA as to why it is not allowed in the US and it boiled down to a screw up in the paper work from a foriegn company, deligimitizing the test data, thereby disqualifying the drug for further testing. It could be tested again if an American company were to submit it for testing, but basically there currently isn’t enough customer base.

The interesting thing that I got from Dr. Haines office was that somebody has recently started testing it for migraines. I really couldn’t find anything substantial confirming that but it is basically the last med on the list for me, so I got my hopes up. Between the debatable data for meniere’s and the lack of material for migraines, I find it a little hard to hold my hopes to high, but I got them up there anyway. :slight_smile:

Hi DizzyIzzy

Yes, all this about Serc is interesting isn’t it? It was many years ago that I took it, probably 15 or so. I was desperate back then as after 20 odd years of unpleasant yet fairy manageable symptoms, I’d taken a bad turn for the worse, so I was willing to try anything. If I remember correctly it was my GP who put me on Serc. Nothing improved so he sent me to all the specialists and it was one of those, the audiologist, who seemed genuinely amazed that I was on it. I recall feeling extremely angry that I’d been given something which according to her would have made the condition worse.

Obviously a lot of time has passed since then and I now realise that knowledge about MAV was very elementary back then and even about migraine too and yet there was something that definitely impressed me about that audiologist that I still have a gut feeling that she knew what she was talking about. But that’s all it is, a gut feeling, nothing more. I wish I’d had the presence of mind back then to ask questions. I was so terrified of how I felt at the time and the hospital visit was so traumatic that I was like a rabbit caught in the headlights. Just get it over with and let me go home!

I do vaguely recall that Serc helped a little with hay fever type symptoms but that is all, the dizziness was untouched by it. I hope the testing that Brian talks about takes place. That would be extremely beneficial.

— Begin quote from ____

My deep down belief in all of this is that if it works it’s all placebo anyway. It’s weird that everyone on this board seems really similar in their symptoms but REALLY different in their reactions to medications

— End quote

Now there’s a thought! Personally, I nearly always have the opposite reaction to meds from what the doctors tell me to expect. It’s caused me endless trouble over the years because no-one ever believed me. It doesn’t bother me any more now though because I know myself and am prepared when this happens and no-one, including doctors, can make me feel guilty about my reactions anymore. You’re right, it’s a VERY individual thing.

And my individual thing for some years now, because of my weird and very unpleasant reactions, has been to cope with MAV without meds.

— Begin quote from ____

And the best bit … 2 squares of good quality plain dark chocolate a day!

— End quote

This may not be such a mad idea! Dr Bernstein in the Migraine Brain says she sometimes recommends her patients eat 1 square of dark chocolate before bedtime each day.

I didn’t need any more encouragement! I got into trouble last year eating too much chocolate. Stupid after not having any for three years. So now I’m doing fine on a couple of squares a week. I’m over the moon to be able to have chocolate again! :smiley:

All the best , Brenda

The following is from Dr. Hain website

Serc (betahistine)
Timothy C. Hain, MD
Please read our disclaimer Return to Index. Page last modified: February 13, 2010

A recent survey reported that 94% of the ENT surgeons in the United Kingdom prescribe betahistine to their Meniere’s patients (Smith et al, 2005)

This drug (brand name Serc, chemical name betahistine), is advocated as a vestibular suppressant mainly for Meniere’s disease. Curiously, Serc was approved by the US FDA about 40 years ago for roughly 5 years, but later approval was withdrawn because lack of evidence for efficacy and because the major report of effectiveness contained deficiencies and misrepresentations (Sampson, 2003). The withdrawal was upheld by a US court of appeals in 1968. Subsequently, four double-blind studies have been done reporting reduction of vertigo attacks with betahistine (Frew and Menon, 1976: Wilmot and Menon; 1976; Meyer, 1985; Mira et al, 2003). Nevertheless, these studies may have been flawed and a recent review suggested that it is presently still unclear if betahistine has any effect in Meniere’s disease (James and Burton, 2001).

Serc was again reviewed by the FDA in June of 1999 (click here for details). Essentially, the conclusion was that there is no evidence that it is harmful, but also little evidence that it has any therapeutic effect. It thus is similar in official status to an inert substance. Serc has been reviewed by the “Cochrane database”, who concluded in 2009 that “There is insufficient evidence to say whether betahistine has any effect on Ménière’s disease”

Betahistine can be easily obtained through US compounding pharmacies, with a prescription. It is difficult to see why an inert substance must be prescribed, but nevertheless, this is the situation in the US. Insurance often covers betahistine too. At the time of this update (2/2010), we generally just send patient to Walgreens.

Rationale for use of Betahistine:

Histamine Betahistine

For those who want the quick answer, nobody has a reasonable rationale of why betahistine should work for dizziness. Following is the longer explanation.

Although betahistine does not closely resemble histamine (see above), in the body it is a histamine agonist. There are 3 histamine receptors - -H1, H2 and H3. The rationale for its use is somewhat difficult to understand as H1 blocking antihistamines (such as meclizine) are also used quite commonly to treat vertigo. Explanations commonly given are that the drug is a vasodilator, or that it acts on subreceptors of histamine. H1 and H2 are post-synaptic receptors and H3 is a pre-synaptic receptor. Betahistine is a potent H3 receptor antagonist. (Lacour and Sterkers, 2001). Stimulation of the H3 receptor reduces histamine release, so antagonism of H3 increases histamine release. H3 receptors control the synthesis and release of histamine via a Gs protein (de Waele et al, 1995).

According to de Waele et al (1995), there are several lines of evidence that suggest that histamine receptors modulate the function of central vestibular neurons. One influence is via axons from the posterior hypothalamus. This may be related to wakefulness as histamine controls wakefulness. Both H1 and H2 binding sites have been detected in vestibular nuclei. These authors note that there is data suggesting both that H1 and H2 actions are excitatory on the vestibular nucleus, and that common H2 blocker drugs such as cimetidine antagonize the effect. This suggests that H2 blockers (commonly used to reduce stomach acid), at least those that cross into the brain, may have a central vestibular suppressant effect. H3 antagonists appear to inhibit horizontal vestibular gain without affecting alertness. This line of reasoning does not explain at all why betahistine would be helpful – one would even think that it would be harmful if it excites the vestibular nucleus. This is just one example of the large array of confusing literature about this drug.

Most antivertigo drugs are H1 blockers. Many newer allergy medications are selective peripheral H1 blockers, and many older allergy medications, including those used for dizziness such as dramamine, are peripheral and central H1 blockers. Many medications for stomach problems that block acid are H2 blockers, but these are not generally thought to affect vestibular function (see above however).

Betahistine is an H3 antagonist, according to Timmerman (1991). H3 antagonism is felt to increase H1 and H2, so the net effect of H3 antagonism is histamine (H1 and H2) agonism. Confusingly though, some authors suggest that betahistine is an H3 agonist. The neuropharmacological literature is also complex. Arrang et al (1985) found betahistine to be a partial agonist against cerebral H1 receptors, and has no effect on H3 receptors. In other words, some H3 agonists might block histamine release, but betahistine (betahistine) doesn’t affect these receptors in guinea-pigs. This would suggest that either betahistine is a placebo, or that it’s effects result from some mechanism other than H3.

As mentioned above, it seems contradictory that both H1 blockers (meclizine) and H1 agonists (betahistine) are advocated for vertigo. It, however, is possible that the antihistamine effects of meclizine are less important than its anticholinergic effects, so there may not be a contradiction between the H1 effects. The general thought at the present is that the effects of betahistine relate to it’s effect on H3 receptors, although what exactly this effect is still rather mysterious. If betahistine is indeed an H1 agonist and an H3 antagonist, it might suppress vestibular function and enhance alertness, both valuable qualities. By this thinking, betahistine could be reasonably combined with a selective H1 blocker that does not cross into the brain (such as fexofenadine).

Is it reasonable to combine meclizine (a central H1 blocker) and betahistine (a central H1 agonist) ? Well, perhaps if you are hoping to use the central anticholinergic properties of meclizine. It would see a more logical, however, to use a pure anticholinergic agent such as scopolamine instead of meclizine. Similarly, it seems reasonable to combine betahistine with a contemporary non-sedating antihistamine, as these medications do not cross the blood brain barrier.

Does it work ?
The author of this review has had moderate success with giving betahistine to patients who have intractable Meniere’s disease, and it part of his usual regimen for intractable Meniere’s (often in combination with verapamil). It comes in doses of 8, 16 and 24 mg.The usual dose is 16 mg 3-4 times per day although greater effect is obtained for doses as high as 48 mg (Strupp,et al. 2008). Most people that report a positive effect can decide this with a few days – it doesn’t seem to take 1 month to figure out whether betahistine is helping or not.

The author also uses Betahistine to treat severe motion intolerance (e.g. Matsnev and Sigaleva, 2007). Betahistine can be used in children (Gryczynska, Drobik-Wasiewicz et al. 2007). While claims have been made that Betahistine is associated with weight loss, these appear to be unfounded (Barak, Greenway et al. 2008).

There are numerous puzzling aspects to betahistine and the jury is still out regarding whether or not it is an effective medication. Some studies report that betahistine cannot be distinguished from placebo. There are also some troublesome reports comparing betahistine to other medications that are almost certainly placebos, that can be interpreted in the same way. Klein et al (1998) reported that a homeopathic medication was equivalent in efficacy to betahistine. As homeopathic medications are generally felt to be placebos because of the extremely high dilutions with which they are administered, this suggests that either the Klein study was flawed, or that betahistine is also a placebo. On the other hand, Fujino et al (1994) reported betahistine to have a positive effect when combined with rehabilitation.

Side Effects
Side-effects are generally minimal. The author of this review has encountered stomach upset in several, worsening asthma, headache (Barak et al, 2007), and chest tightness as side-effects. Of course, these symptoms could be found in a placebo.

Post-marketing studies conducted by the manufacturer suggest only a very small number of adverse effects (Jeck-Thole et al, 2006). In theory, stomach upset might be related to H2 agonism, as H2 blockers are used to treat gastric acidity. Against this idea is that betahistine is not a H2 agonist, but the increased release of histamine associated with h3 antagonism might stimulate H2. As mentioned above, it seems reasonable to combine betahistine with a selective H2 blocker that does not cross the blood brain barrier, or a proton pump inhibitor used for gastric acidity. Headache might also be a direct effect of histamine. On the other hand, some studies report reduction of headache by betahistine (Amelin et al, 2003). See this outside link for more information.

In it’s favor, betahistine does not cause drowsiness and has no effect on driving, reaction time or visual acuity (Betts et al, 1991)

Betahistine may be associated with weight loss. The reason is that centrally acting antihistamines seem to cause weight gain (Hampton, 2007), and by the same token, histamine agonists may cause weight loss. According to a study of Barak, weight loss (averaging 4.24 kg) was confined to women below the age of 50. (Barak et al, 2008).

According to Vlastarakos et al. (2008), Betahistine is contraindicated in pregnancy. While we agree that it is prudent to avoid use of drugs lacking rigorous data in pregnancy, the advice in this case does not appear to be supported by any adverse event data.

Incompatibilities ?
Little has been published on this subject. If one believes in the histamine agonism mechanism, it would make little sense to take a centrally acting antihistamine medication with betahistine as the betahistine might not work. This covers a lot of ground including many conventional “dizziness” drugs. A person on betahistine should be able to take purely “peripheral” acting antihistamines (such as Claratin, Allegra and Zyrtec). Similarly a person on betahistine should not take antidepressants with central antihistamine side effects such as the “tryptylines”. This includes Elavil and Pamelor. Practically, we have not noted any interaction problems.

Thanks for the info, I’m not very good at researching these days, and that helps a lot. :slight_smile:

I have been on serc for over 10 years, it took a few weeks to help. I am not as bad on it as I was years ago without it. When I forget to take it or cut down I can tell the difference.


Just want to add that I take Serc for Menieres.I and my doc are leaning towards MAV involvement.
I asked her about it last week and she said that it can help with Migraine.
Don’t know how effective it might be,but am not surprised that you have gotten some relief.

Sorry to bring my slightly old thread up again but it might be useful to some people to know the latest.

I woke up moderately dizzy this morning after a week of near normality (about 95% better). Had a coffee a few days ago but have otherwise stuck to migraine diet, and I’d had a reasonable night’s sleep so I was a bit worried and thought ‘here we go again’. I was due to start my VRT today but the physio said if I was feeling bad I shouldn’t so we postponed it for a week. Anyway, when I went to take my betahistine at breakfast I discovered I hadn’t taken last night’s tablet (the tablets come in packets of 21 with the days of the week on so you know if you’ve missed one). Well, it’s now evening so I’ve had my 3 tablets for today. I also took a Piriton for good measure as this seemed to help before, and now I’m more or less back to how I was yesterday, which is really nice. :smiley:

So the placebo effect can’t be the case here as I didn’t realise I’d missed a tablet till after I felt dizzy.

Looking forward to seeing my otoneurologist to report all this, but it’s not till September…