Hey Ben,
I know that Dr. Newman in NY (he’s my doc) as well as Dr. Furman (he’s a big deal in vestibular disorders including MAV at Univ. at Pittsburgh) are strong believers in Zoloft. If my verapamil trial fails or my improvement stops I will be adding a low dose of zoloft. But, as we know, it is so hard to tell if a medication will work until you try. There is a paper by Jeff Staab (Scott, I don’t know how to post papers) that showed some very positive results for using zoloft in patients with subjective dizziness (not specifically those with MAV), but Dr. Furman told me to check this paper out when I spoke to him.
Good luck!
Lisa
Scott,
When I was considering verapamil, my cardiologist brother-in-law suggested I take it at bedtime and increase my fluids while on it. These steps might help with the dizziness/lightheadedness. I chickened-out and never did start the verapamil but thought I’d pass along the tip. Good luck to you. I wish you success with this drug trial. Kristen
Lisa,
After I speak to the doctor, in the next 3 weeks or so, I’ll post a message on his thoughts on verapamil expectations.
Thanks,
Ed
Lisa,
Is this the article you are referring too? While they don’t talk about MAV per se, I think most of the patients in this study were migraineurs (see group 2 and 3) and they didn’t realise it. SSRIs were very effective as we see here on the forum in many people.
Ben – definitely worth trying Zoloft. Adam is doing well on it and so is another member here. I’ll keep cracking on with Verapamil …
Scott 8)
— Begin quote from “MAVNY”
Hey Ben,
I know that Dr. Newman in NY (he’s my doc) as well as Dr. Furman (he’s a big deal in vestibular disorders including MAV at Univ. at Pittsburgh) are strong believers in Zoloft. If my verapamil trial fails or my improvement stops I will be adding a low dose of zoloft. But, as we know, it is so hard to tell if a medication will work until you try. There is a paper by Jeff Staab (Scott, I don’t know how to post papers) that showed some very positive results for using zoloft in patients with subjective dizziness (not specifically those with MAV), but Dr. Furman told me to check this paper out when I spoke to him.
Good luck!
Lisa
— End quote
Hey Lisa,
Interested to see that you spoke with Dr. Furman. How did that happen to come about if you don’t mind me asking? He’s my main doc! I really like him a lot. Has a great bedside manner and seems to be very informed. I believe he did suggest zoloft and paxil to me as well, but since I did not like SSRIs, we went with Klonopin instead (slightly different med I know, but I like it a great deal). His background as you know is with vestibular disorders and MAV, but less with migraine on its own, so he referred me to another neurologist at Pitt who works more in that area. They interact with each other so I figure the combo for me can only be beneficial! 
Best, Bonnie
Scott,
Sorry that your 2nd time with Verapamil still gives you the dizzies. Maybe if you start at a lower dose? For me, Verapamil has been one of the few medications over the years that don’t give me any side affectss. I guess i’m lucky in that regard. But i do know that it does give me some help on a daily basis… so i hope your able to stick with it.
Keep me posted.
Joe
Does anyone know the UK equivalent for verapamil? Would it be something like propanalol? Thanks.
Brenda
Brenda
I’m not 10% sure but I don’t think we can get Verapamil in the UK. It is different to Propranolol as it is a calcium channel blocker whereas Propranolol is a Beta Blocker, both of which reduce blood pressure but in different ways. There may be similiar calcium channel blockers available, but whether they are effective in preventing migraine I’m not sure.
Sorry I can’t be of more help.
Becky
Thanks for clearing that up Becky. I was wondering if I’d ever had anything like Verapamil in the past. I know sometimes US drugs have different names over here. I thought that might be the case with Verapamil. Obviously not. I’m pretty sure I’ve taken calcium channel blockers before but can’t recall exactly which ones. I’ll check back over my medical notes. Thanks very much for your input.
Brenda
Hey Scott,
Here is the abstract for the paper I was referring to. It specifically looks at sertraline in patients with and WITHOUT psychiatric illness. As always, thanks for your help in posting these things!
1: Laryngoscope. 2004 Sep;114(9):1637-41.
A prospective trial of sertraline for chronic subjective dizziness.Staab JP, Ruckenstein MJ, Amsterdam JD.
Department of Psychiatry, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA. jeffrey.staab@uphs.upenn.edu
OBJECTIVES/HYPOTHESIS: The authors previously reported that selective serotonin reuptake inhibitors (SSRIs) reduce chronic subjective dizziness in patients with and without psychiatric illnesses. To extend those preliminary findings and test the hypothesis that SSRIs may offer a novel treatment for chronic subjective dizziness, the authors conducted a prospective study of sertraline in patients with dizziness for more than 6 months, in the absence of active physical neurotologic illness. STUDY DESIGN: Sixteen-week, prospective, open-label, flexible-dose clinical trial. METHODS: Twenty-four patients with subjective dizziness for more than 6 months and no active physical neurotologic illness were studied. Eighteen patients had major anxiety disorders. Six had minor frustration or worry that did not warrant a psychiatric diagnosis. Sertraline was administered at a daily dose of 25 mg, which was increased to a maximum daily dose of 200 mg. Dizziness, functional impairment, and psychological distress were measured using the Dizziness Handicap Inventory (DHI) and Brief Symptom Inventory-53 (BSI-53). Treatment outcomes were analyzed using repeated-measures multivariate analyses of variance, with last observations carried forward. RESULTS: Three patients were excluded from data analysis for disqualifying medical conditions, one for protocol violations. Fifteen (75%) patients completed treatment. Five (25%) withdrew for adverse effects or lack of efficacy. The median daily dose of sertraline was 100 mg. Sertraline significantly reduced scores on all three DHI subscales and the BSI-53. Eleven of 15 (73%) patients who completed treatment had a positive response, including 8 of 11 (73%) with major anxiety disorders and 3 of 4 (75%) with no psychopathological conditions. Six patients enjoyed a full remission of symptoms. CONCLUSION: Sertraline significantly reduced chronic subjective dizziness in patients without active physical neurotologic illness, including those with and without psychiatric comorbidity.
Hey Bonnie,
In my 18 month journey to finally recieving a diagnosis of MAV, I started contacting all the top vestib. docs around the country. I live in New York and my case was not very clear cut at first (who’s case is???). A lot of times when you tell the office you are another physician they are very responsive. I sent him all my records and we had a very robust discussion via email about my condition and he then suggested sertraline at a low dose and saw very good results with his patients. I was very appreciative of all the time he spent with me. I have also spoken to Dr. Rauch and Dr. Buccoholz on the phone, and both were amazing and very generous with their time and knowledge as well. This was all before I finally got my official diagnosis with my New York doc (Dr. Newman), who I see in person. I also know that Dr. Furman likes clonazepam too. I actually have been on 0.5 mg a day when my dizziness began 20 months ago but it has not really helped much.
Best of luck to you!
Lisa
Scott, hang in there…give it some time. Remember that migraine likes routine, so if you go and jumble what is "normal "for migraine, by adding in a pill,it will give you a fit. Also, I am not sure that the verap is the thing putting you in a tizzy. I am just not convinced that it has even metabolized in your system at this point. TRY TRY (Believe me I know its hard!) TRY to hang in there and give this one a fair shot.
I am thinking of you and were here for ya!!!
Pam
— Begin quote from “MAVNY”
Hey Scott – Here is the abstract for the paper I was referring to.
— End quote
Hi Lisa,
I had this one sitting on my drive. There’s so much to add to the site when I can find more time.
http://www.glycemicindex.com/sd/sertraline_preview.png
http://www.glycemicindex.com/sd/prospective.trial.sertraline.04.pdf
Scott 
[size=140]Note the conclusion from this study[/size]:
The present prospective clinical trial found Zoloft (sertraline) to be efficacious in reducing chronic subjective dizziness in 20 patients (out of 24) without active, physical neurotological illness. Eleven patients had their symptoms reduced by more than half as measured by the DHI, yielding a positive response rate of 55% for the entire cohort and of 73% for those who completed treatment. Six responders enjoyed a complete remission of their dizziness. Outcomes were not dependent on the presence of psychiatric comorbidity; patients with and without major anxiety disorders responded equally well to treatment. Future placebo-controlled clinical trials are needed to confirm these observations and elucidate the mechanism of action of sertraline for patients with chronic subjective dizziness.
That’s it Scott! Thanks for all your hard work with the site.
I agree with what Pam just wrote. Try to hang in as best as you can and keep us posted!
Best,
Lisa
Thanks Pam and Lisa! I’m going to stay at this. How do you think I should gauge increasing this stuff Lisa? Should I expect all side effects to subside do you think on 10 mg before moving to 20?
My head is still in a very strange funk today and I’m having trouble with my memory but keen to carry on. Maybe, just maybe, it’ll work!
S
Hey Scott,
Glad to hear you are still pressing on but of course sorry that you are having a rough start. As far as the dose increase, it is really hard for me to say as I am unfamiliar with treating MAV patients. My main concern with verapamil would be from a cardiovascular standpoint, meaning, is the patient’s blood pressure and pulse able to handle this level of medication. 10 mg as you know is a teeny dose and would not even be considered a starting dose for a child or a frail elderly patient so I am not concerned that this med is affecting your cardiovascular system in any way. Now, all that being said, I think it would be “safe” to increase the dose, but I also believe you should report these symptoms to your doc to see if he or she has any other MAV patients with similar complaints and how your doc deals with a verapamil titration schedule.
Keep me posted!
Lisa
Hey Scott
Those low dosages shouldnt be knocking you around too much, so it could be anything that is ramping up your symptoms.
As a matter of reassurance, and I am quite med sensitive, I started taking 120mg a day and then 240mg a few days later. I pretty much followed Hain’s instruction on his website.
Good luck and hope its the one for you.
Luke
Scott - a doc once told me that if you have a strong reaction to a drug that it might indicate that you will respond well to it. I sure hope that will be true for you.
Just saw this thread Scott, geez, sorry you’ve had a tough time on this. I never took Verapamil so I am unaware of the side-effects but I can say this…I would not move onto the next dosage until the dizziness from this first dosage goes away or at least gets controlable. It sounds like this took you for one heck of a ride! If you have a BP cuff, take it anyway just to SEE if it’s having any effect. you can have an overall lowering of BP and not feel light-headed. You can have generalized dizziness so check it out and see. Let us know
Rich
Hello all,
This med is kicking the %^&$ out of me. I simply cannot believe it … it’s supposed to be one of the easy ones yet I feel like I’ve been pickling my brain in gasoline for 5 days now. I’m waking in the mornings feeling more and more black and dizziness keeps coming in very heavy waves as I move around. It’s turning me into a detached dizzy zombie. This is all of very great concern because while I could probably tough this out if I was able to just stay home etc, the reality is that I have a job that requires me to be operating on all 8 cylinders whenever I can (most days I’m running on 5-6 cylinders). This coming week I have to drive 120 km south and then a similar distance west on Wednesday to observe some group sessions. Driving for me becomes a serious problem when I’m not the full quid because the dizziness becomes more than I can bare. I’m supposed to be managing people delivering a course to participantd at high risk for diabetes and can’t possibly show up looking and feeling like I’ve been in the ring with an 800 lb gorilla. Man, this junk really blows. :evil:
Scott