Hi everyone,
Well, I went to see a dizzy doctor (neuro-oto) yesterday. The visit went pretty well. We spent an hour and a half going over each and every symptom since this all started and he spent a lot of time answering questions. He said that pretty much every person that he has seen with my symptoms has some combination of inner ear, neck, and migraine going on. He THINKS this probably started with something with my inner ear which started got my dizziness started. My neck then started to compensate for the off balance feelings which then triggered the migraine/dizziness/etc. My symptoms came on gradually (I never really had a “crash”) until they were constant. Before this time I never really had headache or dizziness issues, although I do have a predisposition to migraines (family history, 2 migraines in college etc.). He believes whatever triggered this “stirred up” the migraines and we have to look at the triggers and hopefully things will start to settle down.
He did all the neurological testing and then had me do some walking in a straight line (think…sobriety test) and I failed that miserably, he also had me do a few others in which I was falling to one side. He used a little vibrating tool on my neck and when he got to a certain spot on my neck, the dizziness was overwhelming and I almost got sick. He said he doesn’t believe the physical therapy helped the first time, because my symptoms were still so aggravated. He said to think of it like when someone hurts their knee and goes for PT and even though they are still in alot of pain, on the first visit, the PT takes them running…it’s going to aggravate symptoms and make everything worse.
Sooooo, he wants me to start taking Cymbalta. In his experience, he said he has seen it “calm things down”. People have started using in for different types of pain situations and have seen good results. Hopefully it will help ease up the dizziness…and hey, if it helps with my anxiety over this, that’s a bonus. I am supposed to call him in a month to let him know how it’s going and then we may look at PT again with a different therapist.
I felt good after this visit because I do feel like he listened and took everything in. He did not officially diagnose me with anything but I am going to try this plan and see if it works. I asked him about my prognosis and he said if this is what he thinks it is, I should do very well. I am praying and hoping to see some progress. I’ll keep you all posted.
Sounds like a positive visit. Keep us posted. I think someone here had a good experience with Cymbalta but it is not one of the ones that is used a lot. I tried Effexor and it didnt do it for me. I am moving on to Nortriptyline this weekend and hoping it does it…Ben
Sounds like he was pretty good and the Cymbalta sounds like a good start. I’m not sure I agree with some of the things he told you. What do you think?
my neck then started to compensate for the off balance feelings which then triggered the migraine/dizziness/etc.
It makes sense that the muscles in there might be over-worked trying to keep the head steady. I think it’s much more likely that something like labyrinthitis/VN set off your already dormant migraine brain (that is if you did have a virus before this started … not sure about your history) and the migraine is responsible for your neck pain rather than neck causing migraine. There are balance receptors in the neck … pushing around there might simply stir things up by stimulating the balance system. This happens to me too and my neck pain is definitely from migraine.
doesn’t believe the physical therapy helped the first time, because my symptoms were still so aggravated
I think to be more accurate, he should have said you need to kill migraine activity before any VRT takes place to sort out any mess left behind by VN. VRT is notoriously useless for MAV and often makes it worse. This is a diagnostic tool used by Professor Rauch. He knows it’s migraine when VRT makes the patient consistently worse with no gains made over time. See the quote from Rauch:
— Begin quote from ____
Even if migraine is not the primary cause of some of our patients symptoms, it causes intensification of symptoms to the point that the migraine inhibits treatment of the primary problem. Migrainuers are the only patients who get worse in vestibular rehab PT. I consider this diagnostic of migraine: If I see a patient who tried VPT but quit after 1 or 2 sessions I know they’re a migraineur. The migraine trumps every other dizzy diagnosis. Until I control the migraine, I really cannot treat the uncompensated vestibular neuritis, intractable BPPV, or Meniere’s syndrome.
— End quote
Anyway, none of the above matters much I guess because he has you on a migraine treatment which should clear things up and get you on the road to full compensation. Just be aware that migraine frequently causes neck and shoulder pain. If Cymbalta does the job, I’d say your neck pain will vanish with all the rest of this dizzy garbage.
Thanks for all of your comments. I was so bombarded with information and explanations at the doctor that I may have misinterpreted or mis-explained things. I think you’re summary goes along with what he was trying to tell me … or very close. He agreed that something “stirred up” my dormant migraine brain. He likened it to throwing a huge rock into a calm pond and all kinds of junk comes to the top (he was a big fan of analogies ) I do recall a few weeks before all of this started having a mild flu/upper respiratory virus and my ears, if I recall, felt a bit stuffy, but never gave it much thought until yesterday.
The comments about the PT totally make sense. It was not helping the headaches/dizziness at all, and most times I felt worse. My doctor seemed to be on the same page that in order for it to be effective, your body needs to be at a certain point. I am really hoping the Cymbalta helps to calm things down and get me back on track. I’ll keep you posted.
He likened it to throwing a huge rock into a calm pond and all kinds of junk comes to the top.
I like that analogy! And as long as the pond is not calm, I guess the brain becomes sensitised to light, food, pressure change, skin temperature … and on it goes. What a nightmare.
Even if migraine is not the primary cause of some of our patients symptoms, it causes intensification of symptoms to the point that the migraine inhibits treatment of the primary problem. Migrainuers are the only patients who get worse in vestibular rehab PT. I consider this diagnostic of migraine: If I see a patient who tried VPT but quit after 1 or 2 sessions I know they’re a migraineur. The migraine trumps every other dizzy diagnosis. Until I control the migraine, I really cannot treat the uncompensated vestibular neuritis, intractable BPPV, or Meniere’s syndrome.
— End quote
— End quote
This certainly makes me think that at least part of my problem is migraine. I’ve never tried vestibular rehab PT but just thinking about it is enough to make me feel sick. I can’t imagine even putting myself through the torture of it and dread the day a doctor says to me “how will you know it won’t work if you don’t try it?”.
Scott, do you have a link to this article by Rauch? I’d like to read more.
Colleen, Your doctor sounds great! Spending an hour an half with you and going over all of your symptoms. That would be like a dream come true if it happened to me. I do hope the Cymbalta does the trick for you.
I had forgotten about this post! It was good to re-read what your neuro said about Cymbalta. I have an appt at 3 pm today to speak to my GP about going this route and reviewing Paxil. Paxil has been giving my gut a really hard time and it’s escalated over the last 4 days to the point where cramping is bad, feels like I have reflux (punched in the stomach feeling) and … well let’s just say I have to run to the toilet a lot. I’ve been awakened in the night with the abdominal pain, something I’ve never experienced before.
Did you jump right in at 20 mg or did you work up? Sorry if I overlooked this info if you already mentioned it.
Thanks … Scott
EDIT: back from the doc who told me to dump Paxil given the GI issues. She suggested I try Lexapro again or Cymbalta. I am going down your road Colleen. She also wrote a script for Verapamil but that’s for much later. Cymbalta comes in 30 mg caps here – the smallest. Was thinking of kicking it off at 10 mg Saturday morning.
This could be the one for you!!! I hope the Cymbalta does the job. I am also glad she gave you the script for Verapapmil, perhaps you need two preventatives? Good luck and keep us posted.
I hope so much that this works for you!!! I started with the 20 mg from the start and it was fine. I actually asked my neuro about starting at 10 mg and he said he didn’t think it was necessary, and he was right. I did start off taking it in the morning b/c I got really jittery at first. But, I had very little nausea and really no “bathroom” problems when I started. After 7-10 days, the jitters calmed down and I felt less shaky. After about 8 weeks, I started taking it at night and I’ve been sleeping fine. Please keep us posted…I’m here if you have any more questions, etc. Good luck!!
Colleen