Why does subjective vertigo & dizziness persist?

Hi All,

Here’s an interesting paper which confirms what we have discussed here over the years – that it is critical to get an anxiety or depressive illness under control in order to fight the dizziness battle. They make some observations too about vestibular migraine in all of this.

http://www.glycemicindex.com/sd/persistence_vertigo_after_one_year09.png

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Abstract
The overlap and interlinkage of dizzy symptoms in patients with psychiatric and vestibu- lar vertigo/dizziness disorders is the subject of an ongoing debate. In a one-year follow up in 68 patients with vestibular vertigo syndromes, the persistency of vertigo and dizziness symptoms was examined and correlated with vestibular parameters and results from a psychiatric evaluation. Patients with vestibular migraine showed poorest improve- ment of vertigo and dizziness symptoms over time. In addition, patients who developed anxiety or depressive disorder after the onset of the vestibular disorder showed poor improvement and high persistency of symptoms.

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… patients with vestibular migraine or Meniere’s disease and patients with signs of an anxious and depressive reaction should receive early interdisciplinary treatment and psychological de-escalating intervention.

http://www.glycemicindex.com/sd/persistence_vertigo_after_one_year09.pdf

Scott 8)

Then again, who wouldn’t be happy if they’re symptoms were diminishing? And who wouldn’t be sad if they weren’t? These facts are not always so easily interpreted in my opinion.

My interpretation is something like this: vestibular migraine kicks in for whatever reason, from migraine dizziness beginning in the mid 30s for most or perhaps another inner ear disorder kicking it off (my case). The person understandably freaks out not knowing what’s happening to them and with continuous relentless symptoms, anxiety and depression set in. The vestibular migraine itself also produces anxiety and depression on a purely physiological level. The new anxiety and or depressive state acts to keep the migraine brain sensitised and acts as a trigger further promoting migraine which, in turn, fuels dizziness. So unless the person suffering can either somehow get a handle on what has happened and pull themselves out of the downward spiral via counselling, CBT or just and understanding of what has happened (an almost impossibe task given the fact that this illness screws up a person’s reality as well, as in feeling surreal and derealised), such an individual benefits from some sort of SSRI OR a drug that stops the dizziness first allowing for recovery from the depression/anxiety. A tricyclic seems like the better choice in theory because it takes out migraine AND depression if tolerated. My experience fits the former (Cipramil) and I think Rich’s experience the latter (Topamax). We both went through massive amounts of anxiety but two different drug approaches brought an end to the anxiety and depressive state – for me thus stopping the chronic continuous dizziness. I know it’s not this clear cut for everyone but for whatever reason the rise of psychiatric symptoms is definitely a massive complicating factor in this mess and inhibits recovery.

Scott

that is interesting. It reminds me that when I first became ill this went away as quickly as it came for about 1 month, came back, and then went away for another few weeks, and came back for good, August 07. Perhaps, at the beginning I was not yet depressed or as anxious (just of course concerned and bewildered about what was going on) so my sxs were able to disappear. Who knows though?

Hi all,

Correct me if I am wrong, but the reason so many people with VM did not get better after one year is because unfortunately our condition NEEDS meds to really improve. It is not surprising that MD and VM improved the least because these are unstable disease processes and meds are needed to stabilize these conditions… our bodies cannot generally compensate for unstable processes. When there is a stable lesion such as occurs with VN, the brain does very well in getting the patient back to baseline.

To me, there was nothing proven with this study by comparing apples to oranges so to speak…

Stepping down off soapbox…lol… any thoughts?

lisa

you’re 100% correct, Lisa. My research design professors would be so angered by all these poorly conducted migraine studies. I was, though, glad to see that they at least recognized the longevity of mav. I have very low standards when it comes to these articles, and am just p leased to see anything written about MAV

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Correct me if I am wrong, but the reason so many people with VM did not get better after one year is because unfortunately our condition NEEDS meds to really improve.

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Hmmm! I’m thinking about this one Lisa! In fact, I have now for some months. I’ve never got on with any meds. Always felt better on nothing. But I don’t want to bury my head in the sand and I do want to feel 100% better. So when I read people’s posts who have found great improvement on meds I always wonder yet again if I should trial some meds again but something in me just doesn’t feel it’s for me. Is it fear? I did have some pretty outrageous times on meds in years gone by. I know meds have changed now, but despite appearances to the contrary, I am doing better now than ever before due to dietary/lifestyle changes mainly, and I don’t want to upset the precariously balanced apple cart so to speak.

I realise my improvements are relative and not definitive because they are only ever measured against my personal scale and not against “normality”. In other words, I feel better, can do more etc but I still live in a MAV bubble - can’t travel at will, can’t work outside the home etc… Should I risk my present relative equalibrium, such as it is, in the hope for an even better future or be grateful for the oasis of sorts I’ve reached at the moment? My call I guess.

Will improving sleep patterns, getting a firmer handle on stress, maybe doing a local MRBS course I’ve found, be sufficient to move me along? Or, as you propose Lisa, do I really NEED meds to improve further?

The jury’s out!

Brenda

Hi Brenda,
I applaud your efforts with how far you have come on your own. I am also not surprised many of your med trials have made you feel worse as until we find the right med or combo this is par for the course. It is a personal call of course and I greatly respect your desires.

That being said, from a scientific/medical standpoint, the brain cannot compensate to unstable diseases as I have mentioned and theoretically it would therefore make sense that the only way to stabilize our condition is through exogenous sources (meds). I am not a MAV specialist, but from my speaking with the top specialists in the USA, extensively reading the literature, it does seem that to get to 100% meds are required. We can take it to a certain level through lifestyle and some may even improve with VRT, but other aspects of our illness for most will require medical intervention.

Lisa

very well said, Lisa

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That being said, from a scientific/medical standpoint, the brain cannot compensate to unstable diseases as I have mentioned and theoretically it would therefore make sense that the only way to stabilize our condition is through exogenous sources (meds). I am not a MAV specialist, but from my speaking with the top specialists in the USA, extensively reading the literature, it does seem that to get to 100% meds are required. We can take it to a certain level through lifestyle and some may even improve with VRT, but other aspects of our illness for most will require medical intervention

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I really appreciate your input Lisa. I’ve already been trying to read a little about compensation as it’s not something I’ve ever gone into in depth before. I really would love to get to 100% and I thought that might be possible without meds. It seems I was wrong to think that. Thank you for sharing what you have learnt. I like to always have an open mind and will certainly be giving all this a lot more thought.

Not sure whether you’re able to answer this or not but do you have any idea just what percentage of normal might be achievable without meds? Or is that like asking how long is a ball of string?

Many thanks

Brenda

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Correct me if I am wrong, but the reason so many people with VM did not get better after one year is because unfortunately our condition NEEDS meds to really improve.

— End quote

Hmmm! I’m thinking about this one Lisa! In fact, I have now for some months. I’ve never got on with any meds. Always felt better on nothing. But I don’t want to bury my head in the sand and I do want to feel 100% better. So when I read people’s posts who have found great improvement on meds I always wonder yet again if I should trial some meds again but something in me just doesn’t feel it’s for me. Is it fear? I did have some pretty outrageous times on meds in years gone by. I know meds have changed now, but despite appearances to the contrary, I am doing better now than ever before due to dietary/lifestyle changes mainly, and I don’t want to upset the precariously balanced apple cart so to speak.

I realise my improvements are relative and not definitive because they are only ever measured against my personal scale and not against “normality”. In other words, I feel better, can do more etc but I still live in a MAV bubble - can’t travel at will, can’t work outside the home etc… Should I risk my present relative equalibrium, such as it is, in the hope for an even better future or be grateful for the oasis of sorts I’ve reached at the moment? My call I guess.

Will improving sleep patterns, getting a firmer handle on stress, maybe doing a local MRBS course I’ve found, be sufficient to move me along? Or, as you propose Lisa, do I really NEED meds to improve further?

The jury’s out!

Brenda

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Brenda I can relate to your reasoning and also to wondering whether you can reach a different plato by using medications.

I am somewhat like you as the med trials I have tried so far have been worse than the disease itself.

I have made improvements from where I was a year and half ago with improved sleep patterns, diet modification etc. But I like you am still unable to work , go places alone and really completely move forward so what to do? I have fear of the medications as the experience so far has been bad…for me. And when I hear the many trials some have been through it scares me to think of having to go through that for years on end. Or would I get lucky like Nance did and the first one work.

I think this is a choice we all have to make as to which route to go and which one we feel comfortable with and where we are at in this maze of MAV . Do we want to stay where we are and can we live with being in that place. or do we want to go forward with the medications to see if we can find that “cure” each one of us has to decide that for ourselves and neither answer to me is wrong.

And I do not bury my head in the sand to not think that a medication could work but it is hard to put my body through those additional trials at the moment not to say at some point I may change my perspective. My little dose of Valium keeps me at baseline most days so for now that is where I am.

Hi Brenda,
Yes, you are right, it would be impossible to say to what percentage a person could be of their “normal” without meds. I can’t imagine if a person truly has active MAV, which is unstable as I have mentioned, that they could be 100% without a “stabilizer”. I suppose if someone is not too symptomatic at baseline, diet and lifestyle change could be the stabilizer.

One way to think of this is to compare our condition to someone with seizures. They too can have triggers and many can go long periods without having one. That being said, it would not be good medicine to not prophylactically treat a seizure patient with meds as this too is a fluctuating condtion.

For me, I am not functional at all, so I really do not believe I have a choice in the matter with regards to trialling meds. My diet and lifestyle were excellent at baseline. And, I want to be as close to 100% as possible, so that I can live life to the fullest again someday!

Lisa

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I have made improvements from where I was a year and half ago with improved sleep patterns, diet modification etc. But I like you am still unable to work , go places alone and really completely move forward so what to do?

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Timeless, I could have written your entire post myself, every word of it. That is exactly where I am at. So what to do indeed! :frowning:
Brenda

I also believe it has to do with how ill you are at baseline. I am also not functional at all, and even before pregnancy (without a med that worked) I just got progressively worse and worse. I know that I need a med to break this cycle, but I am also aware that there are difficult side effects. However, my body will adjust to side effects and I simply have no choice. Timeless - I understand what you mean about not wanting to go through many trials. It is exhausting. But, for me, I simply know that it is my only option to getting better. I already tried diet and lifestyle changes for a very long time w/o any success.

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I also believe it has to do with how ill you are at baseline. I am also not functional at all, and even before pregnancy (without a med that worked) I just got progressively worse and worse. I know that I need a med to break this cycle, but I am also aware that there are difficult side effects. However, my body will adjust to side effects and I simply have no choice. Timeless - I understand what you mean about not wanting to go through many trials. It is exhausting. But, for me, I simply know that it is my only option to getting better. I already tried diet and lifestyle changes for a very long time w/o any success.

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I absolutely think that is a true statement Lisa , when your baseline is horrible and you are unable to function then I know that progression to try and get at least to a comfort zone is needed to live instead of just exist. And if it cannot be obtained through lifestyle changes and diet modification then by all means I would go the medication route.

My baseline is much better than where I was but I do have my good days and bad days and I have learned to cope with those the best I can under the circumstances. Plus I am older my kids are grown and my “need” I guess for lack of a better word to do some of the things others have to do, need to do to survive are different … not that I want to live like this forever but I do not want to go backwards…and that is where the medication trials scare me. But that is me and I understand you not having a choice but to go the route of medication. If we all just knew what the magic pill was or could wave the wand and be done with it, then life would be good for us all. In the meantime we have to push forward and fight the battle with the weapons we feel most comfortable with and just hope that one of them breaks this cycle that we all are in day in and day out.

Timeless - what you say makes complete sense. i hope we all find relief one day soon.