Which drug is the drug of choice?

Hi all - Seems I have two types of problems -

  1. constant daily feeling of motion sickness with many triggers making it worse (lights, movement, etc.). While this is very distressing and extremely uncomfortable I am usually able to carry on most activities while feeling like this.

  2. severe eposodic vertigo with no obivious triggers. Unable to do anything when this happens, 100% incapacitating. Would be unable to get out of my house if it were burning.

I have an appt with my doctor tomorrow and want to discuss drugs with him. Currently all I have is valium/meclizine as needed and HCTZ.

Can anyone tell me if the tri-cyclic AD’s help with BOTH of these issues or do they only fix one? Is there anything that will help with both? (beta-blockers are out for me as is Topomax but I’m up to try just about anything else.)

I guess at this point I would say if I had to choose one of the above two problems to eliminate it would be the vertigo. What would be the best drug for that?

Thanks, Book

Hi Book,

I am so sorry to hear of your symptoms and am glad you are going to the doctor to discuss possible preventive meds. I was wondering why topamax is not a med that you can use?

Keep us posted!

Best,
lisa

Hi Lisa,

I tried Topamax for about 3-4 days and it made me quite nauseaus. Also I found it made me very edgy and kind of unable to think. I remember washing the dishes and thinking “what should I wash next, the plate or the glass?” I just couldn’t make the decision, trivial as it was. It upset my whole way of thinking. I need to be alert at my job and Ijust couldn’t when I felt that way.

Thanks, book

Hi Book,
I asked about topamax because there is a study that specifically looked at people with migrainous vertigo (true vertigo like you) that got better with topamax. What dose did you start at? Maybe it was just too high of a dose?

Lisa

Lisa, if I remember correctly I took half a capsule which I think would be 25 mgs. Ialways start with a low dose because like many of us I seem to be very med sensitive.

Book

Hi Book,
I just re-read the study. I had Scott post it a few months ago. In any event, the capsules start at 25 mg, so you probably only took 12.5 mg. I started on topamax and have been titrating at 6.25 mg a week and so far the side effects are tolerable (nothing like you described).

If topamax has been shown to help the population in this study perhaps another anticonvulsant that is easier to tolerate may help? Just a thought…

lisa

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I just re-read the study. I had Scott post it a few months ago.

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Lisa, could you possibly point me to where this study is please. I also have the episodic vertigo like Bookworm which renders me completely immobile at times. I don’t get it so often now but am just coming out of such an episode, so am interested very much in what the study might say although I think I’m too scared to take Topomax given my previous reactions to meds. I don’t want to close my mind though and would like to read what is said about it. Thanks.

Bookworm, how often do you have these immobilising vertigo episodes and how long do they last? They are the pits aren’t they?

Brenda

Sure Brenda… I can’t post it for some reason but I sent it to Scott awhile back.

Hey Scott, can you re-post the study… Clinical Assessment of Topiramate Therapy in Patients with Migrainous Vertigo??? It is from the Journal Headache 2009.

Thanks!
Lisa

— Begin quote from "Brenda"

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I just re-read the study. I had Scott post it a few months ago.

— End quote

Lisa, could you possibly point me to where this study is please. I also have the episodic vertigo like Bookworm which renders me completely immobile at times. I don’t get it so often now but am just coming out of such an episode, so am interested very much in what the study might say although I think I’m too scared to take Topomax given my previous reactions to meds. I don’t want to close my mind though and would like to read what is said about it. Thanks.

Bookworm, how often do you have these immobilising vertigo episodes and how long do they last? They are the pits aren’t they?

Brenda

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Brenda, My attacks have been anywhere from about 3-4 weeks to 13 months apart. The last one I had was over the weekened (first one in a year +, I thought I was through with this) and it lasted 3-4 hours. I took valium at the first hint it was coming but it took 3 full hours before the valium kicked in and things started to ease, then it took another full hour before I could actually stand up. Because it took so long for the valium to take effect makes me wonder if the valium really didn’t help at all and I would have have been better in 3-4 hours regardless if I took it.

I can’t think of anything that would have led to this latest attack and I was actually feeling quite well up until the second it hit me. It came without warning. This makes me think I may have Meniere’s after all and not MAV. I’m going to my doctor later today, we’ll see what he says.

Brenda, how often do you get your attacks? Do you have triggers or warnings?

Book

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Brenda, how often do you get your attacks? Do you have triggers or warnings?

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The bad attacks that keep me in bed for 24 hours at least, only happen about once a year, although in the past six months I’ve had two less virulent ones that only kept me off my feet for a few hours. Sometimes I have no warning at all but on numerous occasions, with the benefit of hindsight, I can see that I’ve been feeling exceptionally tired and heavy headed for some while prior to the attack after pushing myself more than I should have. People have suggested the episodes are down to stress but I don’t feel that myself. But I’m not good at recognising cause and effect when it comes to stress. It never seems quite that simple to me. I do have lots of triggers for my everyday MAV but these don’t seem to play a starring causal role in the sort of episode I’m talking about here.

I’m interested in what you say about wondering whether the symptoms would have just got better in time anyway regardless of the valium, as I had one three week episode in bed a few years ago when the doctor went through the gammet of migraine meds and not one worked to stop the vertigo. It seemed that time was the only healer.

What did the doctor say BTW?

And thanks Lisa for asking Scott to repost. I’ll look out for that.

Brenda

Brenda,

I went to the doctor. We didn’t talk much about medication; he wants me to have the ENG first which I have been putting off for a long time. So that is going to be next week. Then we will talk about drugs. He said probably Topamax. He doesn’t believe in anti-depressants for MAV. My other option with him is a beta-blocker but I can’t take that either because I get allergy shots.

Finding triggers with cause and effect isn’t that easy for me either, especially knowing that it can take 2-3 days for a trigger to actually cause the bad reaction.

A three week episode in bed sounds like pure He**. I wish there were easy answers.

Book