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Old 10-07-2007, 08:26 PM   #1
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the link between hormones and dizziness

... and the reason there are so many more women than men on dizziness forums.

I referred to this in another post, and thought I should post the abstract. The full paper is floating around on the web as well. If you need any assistance deciphering any part of it, just ask.

Association of progesterone receptor with migraine-associated vertigo.
Lee H, Sininger L, Jen JC, Cha YH, Baloh RW, Nelson SF.

Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, 90095, USA.

While migraine has been demonstrated to be familial and have genetic contributions, genome-wide linkage analyses and candidate gene studies have highlighted that migraine is genetically complex. Despite substantial efforts, no consistent replication of linkage or association has been reported for common migraine syndromes. Among the candidate genes tested for association with migraine by several groups were female sex hormone genes based on the observation of a much higher incidence of migraine in females. Migraine-associated vertigo (MAV) is a migraine syndrome also much more common in females than males. Because MAV is less common in the general population than migraine or migraine with aura, it may be a better migraine syndrome to detect susceptibility alleles. In this study, we tested the association of two female hormonal genes, progesterone receptor (PGR) and estrogen receptor (ESR1), which were previously reported to be associated with migraine in women. We typed 150 MAV subjects and 145 genomic matched control subjects. One SNP (rs1042838) within PGR, which is in high linkage disequilibrium with the functional PROGINS variant, was significantly associated with MAV (p = 0.0007). Two SNPs (rs2228480 and rs1801132) within ESR1 demonstrated no significant association. No synergistic effect between ESR1 variants and PGR variants was identified.


Adam

 
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Old 10-07-2007, 09:07 PM   #2
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Re: the link between hormones and dizziness

quite interesting adam! i remember you saying in one of my posts that you took neurontin??? did i remember correctly? if so, how long and at what dosage did it take to benefit you? i have read some research about it being used for migraine preventative as well as in some cases for oscillopsia--but not being caused by vestibular issues....have you read anything about that as well??? i havent taken it since the one time, i wanted to get off the xanax and try again. well, been off the xanax for about 5-6 weeks now and i think i'm ready to give it a shot again...i just hated how it made me sooooo tired

sorry to ramble..but just wondering

 
Old 10-07-2007, 09:39 PM   #3
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Re: the link between hormones and dizziness

Hello

Yes, I currently take neurontin 300mg a day (I have been as high as 2400mg but in terms of benefit vs side effects, I find 300mg has a decent effect on the dizziness). I also take levieteracetam (keppra) 500mg a day and pizotifen 0.5mg a day.

I think you might be referring to the use of neurontin in various types of nystagmus (downbeating etc.) rather than oscillopsia. Central forms of nystagmus.

It will make you tired, dizzier, and maybe even more foggy to start with. These things do tend to get better quickly though, and if they don't, you just drop it and try something else.

Adam

 
Old 10-07-2007, 09:57 PM   #4
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Re: the link between hormones and dizziness

thanks! how long do you suggest using it and having some of the initial effects before noticing a difference or knowing when to drop it??
thanks so much!

 
Old 10-07-2007, 10:28 PM   #5
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Re: the link between hormones and dizziness

I would personally give it a month at the maximum dose you can tolerate (2400mg seems like a commonly chosen limit). I believe it does not get metabolised by the liver at all so you can get away with taking quite a lot of this drug.

You need to get there slowly though, so follow the dosing recommendations. I was going up 100-300mg every week or so. Same deal when you're tapering off it too (if it isnt working or you need to stop it).

Adam

 
Old 10-08-2007, 08:40 AM   #6
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Re: the link between hormones and dizziness

Very interesting indeed. So Adam, do you think this article is saying that progesterone rather than estrogen is the main culprit when dealing with the disequilibrium (MAV) issue, and if so, is it too little progesterone or too much? I am thinking too little. I have just now started doing some research on this how much hormones can wreak havoc, including all of the weird symptoms we talk about here on this board. I was sort of leaning toward the suspicion that is may be due to lack of estrogen. But it looks like this abstract you provided is focused a little more on progesterone as the cause. Hmmm, this is really interesting.

I just got this book and it said to do hormone testing 7 days before ones period. When I did hormone testing I was told by my doc to do it 3 days after, where my test results showed 27 for estrogen. The book I am reading said anything below 80 is too low. But my doc didn't say I had abnormal readings at all. Arrrrrgggg - looks like it's time for another specialist (hormone) as opposed to the ol' GYN. I was told that it is better to get a nurse practioner to help in the hormones arena as opposed to an OB/GYN doc because they are too busy with other things to deal with our hormone woes. Which is becoming more and more obvious now.

I do not want to take HRT but I have heard/read that there is a natural progesterone cream. I may have to look into this!

I have had a dull headache ever since my cycle began on 9/27 - it definitely feels like a migraine thing. I can't shake it. It's only bad enough to have to take some Advil throughout the day, no vicodin, but still - it is bothersome. I am getting convinced that my problems are migraine related, which is set off by hormone fluctuations. Now the question is, what to do about it? I still do not want to take meds right now. I know there are specific meds that you can take JUST around "that time", but I'm still leary. I also read that your body will learn to adjust to the flucutating hormones - pretty much "get used to it" and therefore the symptoms are eliminated slowly but surely. I'm leaning towards this route - getting used to it, maintaining my migraine diet, and exercising more.

 
Old 10-08-2007, 08:47 AM   #7
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Re: the link between hormones and dizziness

Ok, I read the paper..... well, skimmed through it (I'm not a biology major - and for a good reason!). I think I'm going to have to do a lot more reading about MAV in general to have any meaningful discussion on this.


Your assumption seems to be that most women with vertigo have MAV. Why is this? This particular study has a very specific sample of those with diagnosed migraines with and without aura who additionally have MAV (though I'm not sure how they diagnosed that. Does the paper mention it?) I know you've mentioned before that labs/nv are rare disorders. Additionally women are much more likely to have vertigo/dizziness disorders (of all kinds?).

The prevalence of women on boards such as these I would completely disregard: even though some diseases might be rare, it is entirely possible that those few who do suffer from them are more likely to seek out help and support on these types of forums. Now throw in some, 'women are more likely to talk about their problems' and you got lots of women with rare diseases on health forums dealing with vertigo/dizziness.

There is definite support that women are more likely to have some vestibular disorders (which ones?). On the other hand, Meniere's, for example, seems to affect men and women about equally yet female hormonal changes appear to increase symptoms in women. Strange.


In the particular study you linked, or quoted rather, the authors excluded those who "underwent extensive neurotologic evaluation to exclude identifiable causes of vertigo by one of the authors" and those with positional vertigo. I probably should've read the whole article but I'm wondering which identifiable causes they excluded, what kind of testing they did to identify them, and why they excluded positional vertigo since that is generally listed as one of possible the symptoms of MAV.

Sorry for the rambling, I'm trying to understand this better. I think I'm having a problem getting my head around the exact diagnosis and methods of testing for MAV. The few things I have read generally mention something along the lines of, "after excluding everything else." Not very satisfactory.



(Please don't take this the wrong way, btw. It's a very interesting paper. It just got me thinking and wondering. So many unanswered questions.)


Edit:

Hi Missy!

I think I'll definitely prod the new doctor to get hormones checked. It seems unlikely to me that I have MAV since the Epley works for me which implies that what I have really is BPPV (I think...at least it makes sense to me.) I'm thinking of heading off to the library and checking out some stuff about hormones so that I'm not completely clueless. I don't think I'll find much about hormones and vestibular disorders, but the connection definitely seems to be there, and knowing which levels are considered normal and which problematic would be good to know.

But yea... even if it is the hormones causing it or playing a contributing factor, what do you do? Diet, exercise, whatever is believed to help decrease symptoms of hormone fluctuations in general? HRT doesn't sound attractive to me at all. Grrr.

Last edited by sipa; 10-08-2007 at 09:03 AM.

 
Old 10-08-2007, 02:56 PM   #8
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Re: the link between hormones and dizziness

Quote:
Originally Posted by missy7777 View Post
I do not want to take HRT but I have heard/read that there is a natural progesterone cream. I may have to look into this!
I have been using a natural progesterone cream for years - it's the greatest invention ever. :-) I just hope they never pass that law making them unavailable to consumers. The big Pharm would love to see that law passed. It has helped me tremendously, hormone wise - I never thought of it being helpful with the vertigo. Maybe I should try to use more and see what happens. The compounding apothecary I get mine from knows more about women's hormones than anyone I know. She also recommended I take MSM sulfer powder every day to get rid of candida albicans - she said the candida can cause fluid in your inner ear and may contribute to vertigo.

 
Old 10-08-2007, 05:06 PM   #9
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Re: the link between hormones and dizziness

Unfortunately it is impossible to conclude that the levels of progesterone are the issue.. the article simply shows that in women with migraine-associated vertigo there is a polymorphism (error) in one of the genes that codes for the progesterone receptor (PGR in the article). Similarly when you hear people talking about 'too much serotonin' and 'too little serotonin', it is an oversimplification of something that is very complex. At the moment, the only thing that you can treat migraine with the many (over 100) preventatives. Sometimes the birth control pill works to control symptoms also, sometimes it doesn't.

sipa - Call my belief that almost all women with dizziness have MAV an assumption - but its an assumption based on plenty of research which shows this. BPPV is very common too. The incidence of BPPV is also linked to MAV and vestibular disorders though, as it appears BPPV is a common sequelae to MAV and other vestibular disorders.

BPPV is very easy to diagnose however. It's not BPPV until you can elicit the characteristic nystagmus and less than 1 minute of rotational vertigo, and then diagnosis is easy.

Menieres is not affected by hormonal changes at all, unless they have been misdiagnosed (which is common). Having been on many dizzy forums since the late 90's I can say (these are just anecdotes) that most with a Menieres diagnosis who say their dizziness follows hormonal cycles do not have hearing loss, which is simply not Menieres (american academy of otolaryngology guidelines).

You are right about the state of diagnosis of MAV at the moment - its awful. That really is the point of this article though. Once a set of gene mutations that cause MAV is catalogued, genetic testing (for the patient, a simple blood test) will be able to confirm MAV. This is the path Baloh is taking - other people are taking other paths - some have shown vertical VOR abnormalities in only migraineurs, amongst many other things.

In my opinion, it comes down to this. The woman who has dizziness has migraine-associated vertigo until proven otherwise through neurotologic testing. There is nothing to lose trialling migraine treatment, and everything to gain. Those who follow a treatment plan properly (i.e. don't give up after the first medication doesn't work in a week) almost always get better.

The article isn't trying to show that the connection between hormones and dizziness is migraine - as that has already become obvious through decades of clinical experience. Baloh is the leader in this field.. he literally wrote the textbook on vestibular disorders for med students (you can find it on online bookstores). They excluded those with any possibility of another condition causing their symptoms so they could have a homogenous subset of people - those with migraine associated vertigo only. This is really the only way to find linkage to particular gene mutations.

I agree that if the Epley is working for you, you probably do have BPPV.

Regarding fluid and the inner ear, noone has ever shown that dizziness or vertigo has anything to do with fluid in the ears (inner, middle or wherever). The cause of Menieres disease is still unknown. A large proportion of the general population has hydrops on autopsy, but have never experienced any symptoms.

Last edited by amww; 10-08-2007 at 05:11 PM.

 
Old 10-08-2007, 05:32 PM   #10
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Re: the link between hormones and dizziness

well..i had my highly anticipated neurotologist appt today (definitely a different dr than the first idiot). he was great! he definitely is leaning toward MAV for me with the oscillopsia. he first wants me to work on lifestyle changes --diet and same sleep/eating patterns....which i am afraid i won't be able to keep up with cuz of college and work, etc. he is ordering the ENG, postography and rotary tests for me. he checked for bppv--and i knew i didn't ahve any of that. anyway....he also mentioned about me being on birth control and checking with my gyno about other possible alternatives than the one i'm on since it is tricyclic and can fluctate hormones too much....well, have that appt, luckily, tomorrow--coincidence haha?!? i thought that was interesting that he mentioned that.

he didn't want to start me on any meds yet...then will try a beta-blocker...he wasn't too keen on the neurontin for some reason...??? he also said he would put a tube in my ear if it kept giving me hell with my ETD---all these weeks of nose sprays hasn't helped one bit.

anyway....pretty neat i suppose!

missy....how ya doin with your vision/dizziness lately??

 
Old 10-08-2007, 05:37 PM   #11
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Re: the link between hormones and dizziness

Yeah neurontin is definitely not the first port of call as it hasn't as much evidence of effectiveness behind it yet. In fact it was about my 15th port of call Works for me though ...

First choices are usually tricyclic antidepressants, beta blockers, calcium channel blockers, sodium valproate and topamax these days.

Just thinking aloud.. this issue can't be dealt with by hormone therapy as yet. This is because the functional result (at the cellular level) of the gene mutations are not yet known. Once they determine the result of the gene mutation on cellular function, they will be able to target drugs that correct or stabilise the functional deficit.

Last edited by amww; 10-08-2007 at 05:42 PM.

 
Old 10-08-2007, 05:43 PM   #12
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Re: the link between hormones and dizziness

Quote:
Originally Posted by admw View Post
Yeah neurontin is definitely not the first port of call as it hasn't as much evidence of effectiveness behind it yet. In fact it was about my 15th port of call Works for me though ...

First choices are usually tricyclic antidepressants, beta blockers, calcium channel blockers, sodium valproate and topamax these days.
hey! thanks for answering! did you also have any oscillopsia with all this junk?? i'm assuming your problem was MAV? are you back to your old self after all this??

 
Old 10-08-2007, 09:31 PM   #13
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Re: the link between hormones and dizziness

Yep, MAV

I wouldn't say I'm "my old self" but I've got it to a point where it takes more to crank up the migraine activity, and when it does get cranked up its a lot less severe. I work an absolute minimum of 40 hours a week and have pretty much a normal life nowadays. If I stop the preventatives, all hell breaks loose.

I don't believe I have any oscillopsia - I mean I do have bouncing vision - but I'm thinking of a stricter definition for oscillopsia - basically looking at the horizon you would see a blur, rather than see it bouncing. Oscillopsia is called by saccades (slower, less accurate eye movements than those produced by the vestibulo-ocular reflex [VOR]). I don't have any reason to believe my VOR has been affected at all.

 
Old 10-09-2007, 09:47 AM   #14
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Re: the link between hormones and dizziness

Well, yesterday I had a migraine attack so today I am "hungover". I call it a migraine hangover. The weekend I was ok - BUT on Sunday I went to a soccer game which was HOT and sunny, and then to top it off I cheated on my migraine diet for lunch and had all sorts of "no-no's". It was actually a healthy lunch - I got a veggie sandwich - but the problem was that almost all of the veggies on the sandwich were migraine triggers (tomato, avocado, onion, olive, vinegar). And I am also mid-cycle ovulating (hormone hell). What was I thinking??!!!

So, needless to say, Monday, I woke up with a headache that kept getting worse little by little. I ended up taking 6 Advil, then had to leave work and go to my dark room where I popped 1/2 vicodin and a Reglan and waited for it to pass. I still have a dull headache today and am swaying and a little nauseated.

Yep - DEFINITELY MAV!! Ater yesterday I am actually considering trying Frova around the times when my hormones are fluctuating. I think it would be safer than messing around with HRT. From what I have read, Frova seems to be pretty successful when treating mentrual migraines, and you don't have to take it every day. Not too many side effects either (supposedly).

Alexi - why don't you try Frova for us and report back how it does for you!

 
Old 10-09-2007, 12:10 PM   #15
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Re: the link between hormones and dizziness

Quote:
Originally Posted by missy7777 View Post
Well, yesterday I had a migraine attack so today I am "hungover". I call it a migraine hangover. The weekend I was ok - BUT on Sunday I went to a soccer game which was HOT and sunny, and then to top it off I cheated on my migraine diet for lunch and had all sorts of "no-no's". It was actually a healthy lunch - I got a veggie sandwich - but the problem was that almost all of the veggies on the sandwich were migraine triggers (tomato, avocado, onion, olive, vinegar). And I am also mid-cycle ovulating (hormone hell). What was I thinking??!!!

So, needless to say, Monday, I woke up with a headache that kept getting worse little by little. I ended up taking 6 Advil, then had to leave work and go to my dark room where I popped 1/2 vicodin and a Reglan and waited for it to pass. I still have a dull headache today and am swaying and a little nauseated.

Yep - DEFINITELY MAV!! Ater yesterday I am actually considering trying Frova around the times when my hormones are fluctuating. I think it would be safer than messing around with HRT. From what I have read, Frova seems to be pretty successful when treating mentrual migraines, and you don't have to take it every day. Not too many side effects either (supposedly).

Alexi - why don't you try Frova for us and report back how it does for you!
hehe....i will have to ask my new doc when i see him again for the battery of vestibular testing that i have long been awaiting. he mentioned beta-blockers...but we'll see. i am see the gyno today and will mention all this to her, and i need to see if switching my birth control would help at all????hmmm sorry you had such a bad time with all the migraine yesterday. i am just really convinced that mine are stress related, rather than food....but i dunno. i have only had two migraines with all this (since june) that actually put me in the bed..and both were when i got stressed out...hmmmmm...
hope you are well very soon missy! i'll letcha know what they say hehe

 
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