Visual Vertigo

Specific Illnesses & Conditions VM/MAV
1

Hi All,

Since returning home from holidays and being back at work, I’ve really being seeing things much more clearly and where my achilles heel lies with this dizziness garbage. It’s interesting that while in the thick of it all, it becomes very difficult to sort through what’s really going on in terms of triggers and what the root cause is exacerbating things. The main thing I’ve noticed is this:

I’m back on a computer for 6-8 hours a day and with that my symptoms have changed since the holiday for the worse, and it’s happening fast. In other words, things are heading back to how they were before I left and reestablishing themselves as they were. The main thing that has been fired up again is visual vertigo, that is vertigo triggered by visual stimulation, namely focusing on a Macbook screen all day long. The consequence of this for me is that, over time, it starts to affect my feeling of well being. It seems to slowly but surely turn the screws and by the end of the day I feel more and more flat and even anxious. By contrast, in Thailand I was on my Mac no more than about 10 minutes a day. By the end of 12 days my mood was absolutely great, my confidence was high, and I felt like my usual happy self despite having some nasty rough patches post massage and motorcycle riding. So visual vertigo of the sort created by typing (eyes flicking around the keypad because I cannot type without looking down) and looking at a computer screen is a direct trigger of migraine-related depression and anxiety and feeling unwell.

An SSRI (Cipramil) then did two things for me: 1) it lowered the ability for visual vertigo to be kicked off (raised threshold) and thus stopped the serotonin-happy chemical drain, and 2) kept serotonin topped up even if there was a small draining process going on throughout the day via visual stimulation. I wonder how many of you might also relate to any of this? Of course, if I rev up migraine activity, it means that I am even more likely to have visual vertigo occur which in turn means feeling worse (depression and anxiety) which further fuels migraine. Maybe this is why Effexor is supposedly such a good med for some people because it really kills the ability for visual vertigo to occur. George, I think you mentioned this.

This visual vertigo is something that has plagued me since day one, the day I got hit with VN. So I wonder if this is a bigger issue for me having had vestibular damage versus someone with pure MAV only or does it matter at all? Probably doesn’t matter because if someone’s migraine is hitting the vestibular system hard, then clearly visual vertigo is/ can be a serious problem. I know many of you get set off by walking through the supermarket or by looking at tiles on the ground while walking or just lights flickering.

Anyhow, I’m just thinking out loud about the mechanisms at play. It doesn’t change anything … I can’t not work on a computer so it means getting a drug down the hatch that either stops this visual stuff or at least drops it to much lower levels and prevents it from draining away happy chemicals.

Reading through the literature suggests that those with visual vertigo have a working diagnosis of a poorly compensated peripheral vestibular disorder, a psychiatric component that could be responsible for either producing or worsening the symptoms, and my guess, that migraine activity keeps fuelling it and never allows the brain to compensate. The latter is Steve Rauch’s point of view: kill the migraine and then compensation can occur.

Scott

2

It’s all enough to make one wonder why a dual-mechanism drug, an SNRI, sees so much success (in Hain’s office anyway) for visual dependence – and why he says SSRI’s are ineffective. (Maybe he doesn’t try them often enough in visual-vertigo cases?) It does seem pretty clear that serotonin would be the main thing one would want to target for visual vertigo; persons with sensory-integration disorders often have a serotonin imbalance (deficit).

I’d STILL like to figure out what role norepinephrine has in this. Some people do well on SSRI’s, some do well on SNRI’s that mainly hit serotonin (like venlafaxine), and some do well on SNRI’s that primarily affect norepinephrine (like amitriptyline).

My guess, no two MAV cases are alike.

3

Hi George,

persons with sensory-integration disorders often have a serotonin imbalance (deficit).

An interesting point. Does anybody on the board think they’ve eliminated visual vertigo with meds other than anti-depressants?

Scott

4

Gosh you guys are getting very technical - too technical for me to follow anyway! As you know Scott, I have had success with Nortriptyline, Amitriptyline and more recently, Pizotifen.

Oh, and interestingly, when I first got dizzy back in 2002 a collegue of mine in the office was dizzy at the same time. We were both diagnosed with labyrinthitis by different doctors. He recovered, I didn’t. My theory in the early days was that my long history of (more traditional) migraine hindered my compensation. He had no history and therefore recovered. Now that I’m killing the migraine, perhaps I’m finally compensating??

5

Hi Jen,

Sorry if it’s too technical sounding above … the bottom line is that this visual vertigo is a nightmare as we both agreed, particularly with computer screens. It was really good chatting to you earlier about this today and hearing your view and perspective from someone who just fell into the MAV hole and got out again rapidly with a pizotifen/ ami mix. I just took 0.25 mg piz 15 minutes ago … I’m going to stay here for a few days and then hit the full 0.5 on Monday.

Your labs story is right on the money and am certain that’s what happened to me and hbep (and emsybobs - remember her?) on the HB years ago – no recovery because of migraine as you pointed out. Rauch says this over and over again (as did Halmagyi here in Sydney) – if he cannot kill the migraine first, compensation and recovery do not happen from labyrinthitis, VN or BPPV.

Scott

6

This whole thread is very interesting to me. I also have visual vertigo caused mostly by computer use. I am a paralegal/legal assitant and spend at least 7-8 hours a day in front of a computer. I have to walk away at times during the day. My vertigo makes me feel like I am moving or tipping when I am actually sitting still. All the eye movement from paper to keyboard to computer screen, etc. just drive me nuts. This also started for me with BPPV. My migraine status is also effected by fluctuating hormones at menopause. So taking any medication to stabilize this will be a lost cause. Until my hormones stop fluctuating and my body accepts my new levels I guess I will continue with migraine and to complete that circle my compensation will not be complete until all this happens. In the meantime, I try all the coping mechanisms I can. I try to exercise often, I usually go to the gym 4 times a week, I try to practice yoga, I take many breaks from my computer during the day, avoid caffeine, etc. I did try Lexapro at the beginning of all this and the slightly bit was horrible, it made me very sick, nauesous, dry heaving, not sleeping so I couldn’t go any further. So medication is not for me.

7

— Begin quote from ____

Reading through the literature suggests that those with visual vertigo have a working diagnosis of a poorly compensated peripheral vestibular disorder, a psychiatric component that could be responsible for either producing or worsening the symptoms, and my guess, that migraine activity keeps fuelling it and never allows the brain to compensate. The latter is Steve Rauch’s point of view: kill the migraine and then compensation can occur.

— End quote

This is exacting what Dr Hain also told me. I continue to have 60 migraines a month despite using 3 preventatives (4 if you count Atacand that I take for hypertension) and cycle through 3 abortives. I have persistant HAs! But somehow I think I am getting better. I don’t like it when my husband assumes that if I talk about traveling, that I will need to use a wheelchair. I assume that I will walk. I assume that I should use my REI gift certificate to buy snowshoes-despite the fact that I will be sitting in a wheelchair to pay for them at the cash register! I think 2010 is the year that I will get better.

And I keep thinking that this is January. That means that next month Lisa is having her baby and will hopefully be on her way to feeling better too!

Cheers!

Claudia

8

while I’m still not back to “normal”, the sudden visual vertigo (as you called it) seems to have become much better. I’m on a migrainediet and am sleeping soundly but have also noticed that if I miss going out for a walk in what little daylight there is, it will return to some degree in a matter of days.

Don’t know if I was serotonin-deficient, but if there’s any relationship between serotonin and lack of daylight then I would have to guess that yes.

1 Like
9

Hi Scott
Yes, I remember emsybobs!
Well good luck with the Pizotifen. It sounds like a good idea starting on 0.25 - how on earth did you cut that tiny pill in half though? :slight_smile:
I’ve also been meaning to ask - who is your doc in Sydney? Do you have a good one? Are you happy with him/her?
Jenny

10

Hi Jenny,

I cut it in half with a pill cutter! I’m glad I did because it whipped my ass last night. I had one very freaked out sleep, lots of agitation, neck pain this morning, and crawled out of bed as though I had been lying in an Egyptian tomb for 3,000 years. Such fun. Last time I tried this stuff on Cip there was no agitation … it just made me fall asleep as though I had taken an antihistamine. Wondering if it is a different story because of the mix with Paxil?

My doc in Sydney is Halmagyi. I haven’t seen him for over a year now. Last time I saw him he thought I should try Flunarizine! That stuff has an 18-day half-life and is called the suicide drug by some docs. Adam was sick for months after having it years ago. No thanks.

Emsybobs was almost certainly a MAver but was convinced she only had uncompensated labs and wouldn’t take meds. She was right, but uncompenated because of migraine interference.

Scott

11

— Begin quote from “scott”

Reading through the literature suggests that **those with visual vertigo have a working diagnosis of a poorly compensated peripheral vestibular disorder, a psychiatric component **that could be responsible for either producing or worsening the symptoms, and my guess, that migraine activity keeps fuelling it and never allows the brain to compensate. The latter is Steve Rauch’s point of view: kill the migraine and then compensation can occur.

Scott

— End quote

Scott, Could you explain the above in layman’s terms because I don’t quite understand it? Are you saying there is a psychiatric component to visual vertigo?

All this is a bit too technical for me also. What exactly is visual vertigo? Movies and lines that aren’t straight and watching people in rocking chairs or swings, all this and more makes me very “car sick.” Is this considered visual vertigo?

Thanks, Book

12

Hi Scott
Hopefully last night was a one-off and tonight will be better. The first night I took it it definitely acted like an anti-histamine and knocked me out. Perhaps you were just very worried about taking the Pizotifen and that’s why you felt agitated last night. You have been very concerned about taking it haven’t you?

13

Hey Jen,

Actually I was ok about taking it because the previous times it was very doable. Just like an antihistamine. So last night I took half and forgot about it. About 45 min later I realised that my heart rate was up and I was feeling sweaty under the collar a bit, but nothing too crazy. I ignored it but it was worse on lying down, fell asleep and woke about 4-5 times through the night feeling like I was tripping out. At one stage I woke with one leg half way up the wall behind my bed! I had turned around in my sleep. Maybe I was running the Boston Marathon. Very weird.

Book –- visual vertigo is vertigo that is kicked off or made worse when there is a particualr visual stimulation that affects you. So yes, everything you mentioned could be attributed to visual vertigo, that is, vertigo triggered by something you are looking at. I seem to have this all of the time at varying levels day-to-day. Before leaving on the trip, I was having trouble watching Dexter on my iMAc. Driving was more difficult etc.

I think what the take home message is from the paper is that if you have this junk as we do, having a psychiatric issue whether real mental anxiety or even physiological stuff generated by the dizziness (which we have all had in some shape or form) will make the visual vertigo worse … we’re more likely to react to visual stimualtion. The same would apply if migraine was bad on a given day. And if you happened to be anxious and have a migraine, computer use or sitting in the cinema would probably be a nightmare.

Scott

14

Hi Scott

Oh that sounds terrible. The last thing I was suggesting was that your symptoms were pscyhosomatic - that’s the last thing I’d do, I hope you know that. I know from my own experience that when uninformed people tell me that “it’s all in my head” I could commit blue murder!! I really hope it settles down for you and you get some results.

Jen

15

Well, I was trawling through the archives and almost to the day one year ago and here I am still ticked off by the same visual bloody vertigo. This morning a work colleague brought in his GF’s new Macbook Pro with an LED back lit screen. I bought a MacBook Air in December and have not been able to use it at all. I was on the colleague’s Mac this morning for 5-10 minutes, no longer, and I swear I was off my trolley with dizziness for 90 minutes afterwards. BAM, just like that feeling trashed and then followed by a headache. Wrote off the whole morning.

I was speaking to another friend of mine this morning who just scored a new job that sounds great. She told me how she arrived at the new place and they had a brand new “work station” all set up for her. The first thing that went through my mind after my heart sank was “how the hell would I ever cope in that situation?”. New in some job, you’re trying to impress them, and the first thing you say is “sorry but I can’t look at computer screens … just this 3 year old Mac works for me.” They would think I was mad.

It was good to reread these posts – yours was a good prompt George to look into “sensory-integration disorders [which] often have a serotonin imbalance (deficit).”

S

16

The kid has sensory integration issues, and tricyclics make it (and his anxiety) worse. His psychiatrist said that’s because of the effect that tricyclics have on norepinephrine. (I don’t remember if they increase it or decrease it, though.) In any event, I always assumed that sensory integration issues were driven by norepinephrine, not serotonin.

17

Does anybody on the board think they’ve eliminated visual vertigo with meds other than anti-depressants?
I missed this post before. My visual vertigo has almost gone with a combo of propranolol and pizotifen. Or else it could have just got better on its own…I really don’t know, but I am loads better than I was a few months ago. For info, I take 80 mg propranolol and 1 mg pizotifen a day (the propranolol split between morning and night, the pizotifen just at night).

18

“Sorry cant look at computer screens, just this three year old mac works for me” :lol:

Yep, that would definitely impress :lol:

Christine

19

HI
This is my biggie…it’s def a visual thing with me that brings about the disorientation, and the anxiety…all hand in hand. ONe of the doctors I spoke to in the beginning of this mess kept saying “serotonin”…in answer to my problems with pms, with inability to take birth control pills, with some mood issues, with my current situation happenng right around perimenopause…“serotonin”…she’s a hormone specialist/gynecologist, so she sees women going through this stuff a lot. It was like such an easy answer for her. When I took a small amount of Lexapro, I was okay, but couldn’t go up on it without it cranking up my anxiety. I have read that sometimes a persons inability to tolerate SSRI’s due to a high breakthrough of anxiety was a possible underlying bipolar disorder. yikes! Then a mood stabiliser would be either added or used to compensate. I don’t know about all that…Fex made me dizzier…Celexa made me dizzier…however I can tolerate SNRI meds…but still have the visual dizzies 24/7. I have had some good weeks since adding daily Klonopin and nightly dose phenergan/Promethazine…actually have had 100% free days…but they seem to be fading now as my body is either getting used to it, or who knows what. It’s so discouraging. I spent the day crying yesterday because once again, I thought I found my fix, and then I have to watch it fade…it’s heartbreaking…hence why I have never posted on “success stories”…

Kelley

20

,my visual vertigo is a lot better on metoprolol (lopressor)