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What's the difference between MAV and Meniere's

Hi Folks,

Just wondering if any of you good people can tell me the difference between MAV and Meniere’s please?

I’m still a bit confused about what I have, as are my doctors. I’m leaning towards MAV as I have no hearing loss and my vertigo is more of a rocking or falling sensation rather than rotational. I get vertigo a lot in bed and the dizzies by day (especially from flourescent lights!). I get the tremors in my hands and legs in the morning, nausea, and a lot of headaches (nearly one a day). However, I also have some tinnitus, hyperacusis and distortion in my ears along with feeling of fullness and occasional pain. That could be leftover from the initial Labs though. On top of that there is the anxiety, palpatations…the whole shebang. God, writing that down makes it look really awful! : )

Anyway, just wondering if there is a compare and contrast anywhere between the two conditions, or if any of you out there have any info.

Many thanks, and hope ye’re all feeling reasonably well today!

Kerrygirl

Hi Kerrygirl,

This is a really great question and worth revisiting again since I have been learning a few new things lately, namely through dialogue with Prof Steve Rauch and reading the science literature.

Migraine or MAV in this case (a migraine variant) can mimic just about all of the other vestibular problems out there such as Menieres, BPPV, labyrinthitis and even early stages of multiple sclerosis (MS). This diagram is worth a look as it shows the differential diagnoses. In all three vertigo types presented here, MAV is considered.

Recently Rauch pointed out that in most all other vestibulopathies apart from MAV (disease/ abnormality of the vestibular system), both central and peripheral, test abnormalities tend to “cluster”, showing all peripheral dysfunction or all central. Migraine does not cluster, but shows “scattered” abnormalities that have some elements of peripheral dysfunction and some elements of central dysfunction. Cases of scattered abnormalities are almost diagnostic of migraine – or at least highly suggestive. There also seems to be greatly increased test-retest variation rather than consistent findings.

  1. Peripheral: the most common cause is probably BPPV but other causes include Ménière’s disease, superior canal dehiscence syndrome, labyrinthitis and vestibular neuritis for example.
  2. Central: If vertigo arises from the balance centres of the brain, it is usually milder, and has accompanying neurological deficits, such as slurred speech, double vision or pathological nystagmus. Multiple sclerosis is an example of a condition that involves the central nervous system (CNS) and may lead to vertigo.

So one of the things that will often be asked is whether or not you experience photo or phonophobia – both central issues. That combined with test results showing peripheral problems points to migraine. Of course Meniere’s is associated with hydrops and progressive hearing loss in the low ranges, however, migraine can also produce hearing loss. It’s not always clear cut and some may have both MAV and Meniere’s … or perhaps they may even be two branches off the same tree:

Prof Timothy Hain: There is some thought that Meniere’s and Migraine are two faces of the same indistinguishable condition. This may be indeed the case in a substantial number of people. About 50% of people with Meniere’s also meet the criteria for Migraine, and for this reason, it is often a good idea to try the large repertoire of migraine treatments in persons with Meniere’s disease.

So the take home message is that if it’s not clear, the first point of call is to treat it as though it is migraine and see if you can kill the symptoms that way first. Migraine lifestyle (see The Survival Guide) and a migraine medication.

Hope the above makes sense and feel free to ask questions here.

Best … Scott 8)

Thanks so much for your info Scott. I very much appreciate you taking the time to answer. Can I ask please what you mean by “cluster” and “scattered”. I’m not familiar with these terms in a medical sense. I’m learning though!

I have been googling this thing everyday for the last 8 months, and have found it fairly unhelpful, and it can also spiral me into quite a negative state about the whole thing. It’s hard to know what the real facts are when you are dealing with the internet. That’s why I wanted to ask you here as I feel you guys really know what you’re on about. Thanks again :slight_smile:

Kerrygirl

Hi Scott,

I’m reading and re-reading your post and I think I get what you mean now, thanks. Had to look up a few of your terms. Sorry to be slow on the uptake. :?

Kerry – yeah there is a lot of info to sift through out there and a lot of it is just plain wrong. Try not to get bogged down with it all.

You mentioned fluoro lights setting you off, hyperacusis, and rocking. These are three pretty good MAV indicators. Is there any migraine going on in other family members (another strong marker)?

Have a look at this thread for a better description of my other post:

http://mvertigo.cloudapp.net/t/new-information-from-professor-steve-rauch/3781

S :slight_smile:

Hi Scott,

Yes I have an uncle who was on a preventative medication for 20 years for migraine, he use to get dizzy and confused. My aunt gets them so bad she has to inject herself, but think hers is classic migraine. And she only gets it after periods of high stress. My thing is kind of every day and started a few weeks after I had my baby. My vertigo is like being on a boat, or if it’s very bad, going down a tunnel (that’s usually in bed).

Thanks,

Kerrygirl

I forgot to mention, recently I have been having problems with repetetive pattern such as blinds or a check shirt. So there have been some visual things, mostly aural though.

— Begin quote from "scott"

Migraine or MAV in this case (a migraine variant) can mimic just about all of the other vestibular problems out there such as Menieres, BPPV, labyrinthitis and even early stages of multiple sclerosis (MS). This diagram is worth a look as it shows the differential diagnoses. In all three vertigo types presented here, MAV is considered.

— End quote

Hi Scott, I remember you posted a link to a research paper which contained that diagram. I want to re-read the paper but can’t find it! Can you remind me of the link please. Thank you.

Hi Wexan,

Sure … it’s in the MAV Survival Guide now for future ref:

http://www.mvertigo.org/articles/vertigo_and_migraine2011.pdf

S

More to add here from Medscape:

— Begin quote from ____

The overlapping symptoms of Ménière disease and migraine-associated vertigo include episodic vertigo, sensorineural hearing loss, and tinnitus. Differentiating migraine-associated vertigo from Ménière disease may be difficult because of the overlapping nature of the symptoms of these diseases. However, often the patient’s history offers clues that may help make the diagnosis.

When vertigo is present, it may be indistinguishable from the spontaneous vertigo of Ménière disease. One clue that the vertigo is not of the Ménière type is that the vertigo of migraine-associated vertigo may last longer than 24 hours. In fact, a rocking sensation may be a continuous feeling for many weeks to months. In contrast, the vertigo of Ménière disease typically does not last longer than 24 hours.

Symptoms that would support the diagnosis of migraine-associated vertigo as opposed to Ménière disease include photophobia, nonprogressive sensorineural hearing loss, vertigo of longer than 24 hours in duration, a long-standing history of motion intolerance, and dizziness occurring only during the menstrual cycle. Childhood benign positional vertigo is strongly related to migraine-related vertigo.

Migraine and vestibular disease can coexist. Patients who meet the clinical criteria for Ménière disease should be treated appropriately for Ménière disease, even if a history of migraine headache exists.

— End quote

Scott 8)

Some great info there Scott - thanks. As you know I’m trying to sort out if I have Meniere’s AS WELL as migraine (the latter is a definite, no doubt at all) so this info is very helpful.

Kerry - the symptoms you describe sound a lot more like migraine than Meniere’s IMO.

Vic

— Begin quote from "Kerrygirl"

Hi Folks,

Just wondering if any of you good people can tell me the difference between MAV and Meniere’s please?

I’m still a bit confused about what I have, as are my doctors. I’m leaning towards MAV as I have no hearing loss and my vertigo is more of a rocking or falling sensation rather than rotational. I get vertigo a lot in bed and the dizzies by day (especially from flourescent lights!). I get the tremors in my hands and legs in the morning, nausea, and a lot of headaches (nearly one a day). However, I also have some tinnitus, hyperacusis and distortion in my ears along with feeling of fullness and occasional pain. That could be leftover from the initial Labs though. On top of that there is the anxiety, palpatations…the whole shebang. God, writing that down makes it look really awful! : )

Anyway, just wondering if there is a compare and contrast anywhere between the two conditions, or if any of you out there have any info.

Many thanks, and hope ye’re all feeling reasonably well today!

Kerrygirl

— End quote

Hey Kerrygirl

Early on my doctors were going back and forth between MAV and Meniere’s as well. There are a lot of similaritites. Finally a very experienced Neruotologist in both MAV and Meniere’s made the final diagnosis of MAV. It was based on one thing in my case. The length of the episodes. My episodes last 2 - 6 weeks at a time and generally Meniere’s episodes last a much shorter time - few hours to a few days. So with everthing else pointing to being either of them it was the length of the episodes that finally tagged MAV. Not sure that knowing for sure between the two made a difference in my case since so much of the treatments are the same. But I do think it was helpful to have a final diagnosis. Although it did exclude me from a Meniere’s trial with a Cochlea implant at the University of Washington that could possibly end up helping me if it is sucessful with Meniere’s. But I wouldn’t wanted to have done anything to risk that study that could have such a major impact if sucessful for people not only with Meniere’s but other vestibular disorders such as MAV. :slight_smile:

Scott,

Thanks so much for the valuable info. The diagrams really put things into perspective. I’ve been struggling with symptoms (mild to acute episodic vertigo/dizziness, nausea/vomiting, etc.) of what was diagnosed as Meniere’s back in 2012 after a vehicle accident my daughter and I were in. But the Meniere’s treatments weren’t working to minimize the occurrence of such episodes (at least not like they were supposed to for a “regular” person with Meniere’s). Finally my ENT referred me to Johns Hopkins. The doctor there confirmed the Meniere’s diagnosis but said the condition and the treatments are complicated by migraine. Not sure if he meant MAV since I don’t get throbbing, painful headaches like (I thought) most folks who have migraine do, and I don’t have a family history of migraine, but he did mention that my migraine “expresses” itself in the form of vertigo (so maybe he did mean MAV). I remember always thinking this can’t be Meniere’s because the treatments aren’t working. So far my migraine treatments only inc. a list of food to try to avoid. Altho’ I believe I’m improving, albeit very slowly, I still get sick approx. 1-2 times/week, sometimes lasting a few hours to 24+ hours, and almost always feeling light-headed, absent-minded, fatigued, etc. I go back to JH next month. And am trying to get an appt. at their Headache Center. I just want to be/feel “normal” again (as I’m sure everyone else here does). Good luck to all.

Thanks again!
Cyndi

Hi Cyndi,
Although I’ve only had “one” attack…it was Feb 22 and I’ve had symptoms every day since. I agree with how you and Kerrygirl have been told that MM doesn’t usually present that way, but MAV does. I am trying to get a diagnosis also…and not go through 10 specialists and wait for 2 years to know what I’m facing. I am on a strict low sodium diet per the ENT who says I have a Meniere’s variant, and at the same time I am trying to start the Migraine diet to find triggers. This is tricky finding things to eat that satisfy both but I’m managing. I hope you get some answers at Johns Hopkins. I am considering driving on up there for care. Please let us know how you get on and also who you saw that helped you–I might need a name! I am wondering if you can have MAV and never have motion sickness. I’ve never struggled with it. I do have visual vertigo with TV, seeing things move in traffic, computers, etc. But I’m curious about motion sickness because I’ve read it in the criteria and it’s common.
All the best to you as you search for answers,
Shell

Hi Shell,

I highly recommend a trip to Johns Hopkins. I went to JH in early March of this year and saw Dr. Chien. He’s a neurotologist in their otolaryngology dept. He was who answered my big question which was “why aren’t the Meniere’s treatments working?”. In addition to the Meniere’s symptoms I have (tinnitus, hearing loss, spontaneous vertigo/dizziness usually accompanied w/ nausea/vomiting), he said some of my other symptoms that I thought were related to Meniere’s are actually migraine symptoms such as sensitivity to light & sound, too much visual stimuli, visual spotting/streaks, etc. He recommended I continue use of the medications I have for Meniere’s (which is just valium & zofran) as needed and the migraine diet, but he also recommended I make an appt. at JH Headache Center w/ Dr. Rosenburg. I follow-up w/ Dr. Chien next month, but am still working on getting an appt. w/ Dr. Rosenburg, who is booked through Jan. 2014 :frowning: Supposedly Meniere’s will eventually “burn itself out” (at least that’s what I’ve been told by my ENT and Dr. Chien). I wish it would do so sooner rather than later! If you do decide to make the trip to JH, I hope you find the answers you’re looking for. You can also try UVA. My ENT referred me to UVA (before JH), but I didn’t have a good experience there…it could’ve just been the doctor I saw (Hashisaki), but nevertheless I like JH better. Their care, compassion, and overall knowledge seems far better. Take care!

Cyndi

Hi all,
I’m new to the board. For over 10 years I have been diagnosed with menieres, due to hearing loss and tinnitus. Taken diuretics, and other meds for menieres, and none helped. I, however have a history of migraines all my life, aura migraines included. Recently I became menopausal and my symptoms worsen. I went to a neurologist and he thinks is vestibular migraine and not menieres. I have had spinning dizziness attacks that were preceded by migraines. He wants to put me on Nortriptyline and see if I improve. Any thoughts ? I also wonder if any of you have hearing loss? I know it’s rare. Thanks.

Hi Claudia, yes definitely try the nori. There are quite a few out there who get a Meniere’s misdiagnosis. The two diseases resemble each other in the early stages (of Meniere’s). The good news is that a drug like nori can totally eliminate this from your life. You have some very strong migraine indicators.

On what basis were you diagnosed with Meniere’s?

S