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Kirb0 12-14-2005 09:09 PM

stop me if youve heard this one...bppv or migraine?
Ive spent the past few hours looking at the information linked from this message board and really it has just made me a little more confused on exactly what I have and what the next logical step would be to treat it. So that's why I'm going to go ahead and post my symptoms as well and see if ya'll can help me create a good plan of action here.

I've had this for just about a year now. It all started after I got back from class (was in college then) and I sat down and watched some TV (rather than, you know, doing any actual work). So as I'm watching the Scorpion King come to its uninspiring fininsh, I get into a real weird position...instead of leaning forward and watching like normal, I had my head resting on my hands which were placed on the coffee table probably 2-3 feet in front of my feet...point being I was in a real unnatural position, looking to the right, and I have never been in that position before or since that I know of. Don't know why I was like that one day, but I really wish I never did that. As soon as I leaned up and got up I felt like I was going to pass out. So I walked around a little waiting for the blood to flow back to my head...and nothing went back to normal. I laid down on my bed, nothing got better, everything still felt unstable. I didn't specifically see the world moving but I felt...well...unsteady I suppose. I tried eating, nothing changed, I tried taking my contacts out, nothing changed. At this point my heart was absolutely racing (pulse near 100) and I'm sure a lot of the reason it stayed so bad for so many hours was because of an anxiety/panic attack kind of thing.

It wasn't so bad I couldn't move after that, but I felt unsteady all the time, to the point of missing some classes because it was so bad I knew I wouldn't be able to sit in the class for over an hour until it ended. Also I exercise a lot and basically had to stop because when I got done I would have to walk about very slowly for nearly 30 minutes before sitting down or I would feel like I was about to pass out again. So I went to the university clinic and they said I had sinusitis, gave me some nasal spray and some antibiotics. After a week, nothing was better. I was then sent to the neurologist who said it had to be migraines. She prescribed Paxil, which I have a huge problem taking because of the extremely bad side effects it can have. I have other prideful reasons as well and I'm willing to admit that...I don't feel like I should need any kind of mood medicine to deal with mood problems just as I have never used a painkiller during any injury. Finals came up and I knew I had to do whatever was necessary to get better. So I started taking the Paxil and, for the most part, everything was back to being fine. I sometimes still got the feeling...but not very often at all. Still, walking into noisy restaraunts and bars did a good job of setting it off, although the effects were extremely limited when I was on the Paxil.

Once I got near June, I felt like the effects of the drug were starting to wear down. Since I didn't want to be on it in the first place and certainly didn't want to begin the cycle of increasing dosage, I ditched it and things got a lot worse again. So I was then sent to a cardiologist who did an EKG I believe and found nothing wrong with my heart. I wasn't convinced that my ears weren't the problem so I saw an ENT on my own dime and they found nothing. Finally I had a blood test that revealed hyperthyroidism. I started taking some medicine for the hyperthyroidism and things started getting better once again. Not as effective as the Paxil...but significantly effective. Now the thyroid medicine doesn't seem to be very effective anymore (my increased heart pounding seems to be happening more and more) and I'm having trouble with the feeling of passing out...AGAIN. I don't know what to do.

Now, the times I can voluntarily bring this on are when I am exercising (especially after running, and after running I also notice a slight sense of vertigo, as if the world in front of me is sliding away) and seemingly whenever I go into a noisy restaraunt. I've gone into supermarkets without incident, libraries, shops, malls....but it seems like whenever I go into a restaraunt or bar that is noisy its set off as soon as I walk in. Also, it seems now that when I'm driving and I make a complete stop, my body still feels like its moving. This is especially fun when I have my daily 3 hour commute (God bless Atlanta). Also, it seems like whenever there is a dip in the road strong enough to invade the cabin, it gives me that blacking out sensation. that I've tossed out such an unorganized mess, I think you can see why I am so very confused on this. It seems to me that a lot of my symptoms point to problems with the ear...but I can't get anyone to agree with me on that. My family doctor said there was some fluid in my ears but not enough to worry about. The neurologist and the ENT also checked my ears and said there was no problem.

I've been told migraines and the medication prescribed did seem to fix the problem for a while. But my thinking on this is that the Paxil was effective because of the stress I was under and its fixing the symptoms, not the problem. Of course, the increased heart pounding and the weird head position also seem to point to a possibility of neck or head damage to some blood vessels, so I'm undergoing an echo on my neck and an MRI this week to see if there's any vascular damage...but what can I do about my ears? I want to persue treatment on this just to cover all my bases but no one will listen. Is there someone I can see to try and drain that allegedly inconsequential fluid out of my natural hearing aides? I heard from a friend that a chiropracter could do it? As a final note, I started doing the Brandt exercises (going from a sitting position to one side, back to sitting, to the other side, etc, etc...) which are supposed to help with BPPV. After my first time doing it I noticed I had trouble focusing on objects for a few seconds after both the lying down and standing up segments. Now I normally have trouble focusing on things and I have had trouble with flashing lights for about 6 months more than the dizziness...but these positions were giving me even more trouble focusing. Finally, one other effect is I could feel my ears popping on their own as I moved to the various positions, and my left ear felt like it had some fluid coming out of it...but this might have been because I just got done swimming (since summer I have been able to exercise with only 1 instance of feeling like I was going to pass out)

Alright, I've read over this a couple of times to make sure I didn't miss anything and this is about as thurough as I can be. So thanks in advance for all of the help in getting a plan of action ready to fight this thing off. And hey, congrats to anyone who actually manages to read the whole thing, too. :cool:

Sadly, I'm starting to avoid my friends because I just don't want to have to go out with them to noisy bars and restaraunts and deal with this again and its starting to have THAT effect on me, too.

Thanks again.

firechick 12-15-2005 02:56 AM

Re: stop me if youve heard this one...bppv or migraine?
Hi There
welcome to the boards (like you want to be here!).
It doesn't sound like BPPV to me which I had. The vertigo you get is very much positionally related. You put your head in the offending position and you actually spin for a few seconds. There is the residual crappy feeling not unlike what you describe. This can take months to get rid of once you get the ear rocks out of the canal, as there may be been damage done to the inner ear. If you don't experience the dizziness as a direct result of changing position, it may not be BPPV. One way to check is to do a Modified Epeley Procedure (see sticky post at the top of this board and it scroll down to BPPV where it will instruct you on how to do it).
If you get any actuall movement or get vertigo, then you may have BPPV.
The MAV diagnosis is interesting. There are lots of others more qualified to fill you in on the considerations of this, and hopefully they will do so for you. I know the symptoms can be very confusing. IT seems to be more of a process of symptom elimination to get any diagnosis, and even then it will be "possible migraine..."
There are others on this board who have found lots of success with anti-anxiety meds to eliviate symptoms. Sometimes the anxiety associated with inner ear problems is worse than the physical problem. Taking care of the anxiety allows you to focus on the actual inner ear stuff.
Hope you get your answers here!

hbep 12-15-2005 05:24 AM

Re: stop me if youve heard this one...bppv or migraine?

Sorry you have to be here, but I'll try and help if I can. Seems to me there are a few options re your symptoms. Firechick knows a lot about BPPV, and I tend to agree with her, doesn't sound like BPPV.

First off ignore the fact that people looked in your ear and said they couldn't see anything wrong. If you do have something wrong with your ears it's more than likely an inner ear disorder. The inner ear is buried deep inside the head, you can't see it by looking in your ears. I have no idea why doctors persist in doing this and making the ludicrous statement after doing it that 'there is nothing wrong with your ears.' It's like a doctor staring at your chest area and saying nope, nothing wrong with your heart. It's nonsense. There are a tonne of people on this board with both inner ear disorders and migraine related dizziness disorders - virtually none of them will show signs of having anythign wrong when looking in to their ears.

Although I do feel your neurologist could be on to something with the migraine diagnosis, to get checked out for an inner ear disorder you need to see a specialist called a neurotologist. They have 3 more yrs training on top of ENT training in to the inner ear, can run tests and establish if you have an inner ear disorder. Neurotologists are thin on the ground but they do exist and are often linked to balance centres. ENT's are notoriously rubbish when it comes to the inner ear - if I was earned a pound every time someone on here saw an ENT and was told there was nothing wrong with their ears I'd be rich. I am one of those people. Needless to say I and others go on to see neurotologists or neurologists (in the case of migraine) and get a diagnosis.

Before you seek one out however, what's interesting about you is that you have responded to medication on 2 occasions. That is significant. I think one of two things could be going on there. Frequently when people develop an inner ear disorder called vestibular neuritis, also known as labyrinthitis (they sustain damage to their vestibular nerve either from a virus or an unknown cause) they develop a simultaneous anxiety disorder. The brain/autonomic nervous system registers that your balance is off, it believes you are in danger and falling through space, so it goes in to high alert mode, causing panic attacks, palpitations, etc.. This anxiety interferes with your brains ability to cope with the damage to your ear and thus learn how to balance you again (a process known as compensation) and so you go on being dizzy. People who have this problem often get less dizzy when they take an SSRI. That's why the paxil might have worked. It is often very hard to simply override this mechanism with will power - namely - I will think my way out of the panic, as the anxiety is literally triggered by the dizzy symptoms. Some people kick it with cognitive behavioural therapy but often an SSRI is a short cut to getting better much, much quicker. That's why the paxil might have helped. There is a lot of evidence that this might be happening to you - the palpitations, the feelings of being about to black out - these are signs that the dizziness is causing a panic reaction in you.

Alternatively, migraine sometimes responds to SSRI's like Paxil. It could be that for a while the paxil got the migraine under control. It stopped working as frequently people need to up to a higher dosage once the body gets used to it in order to get the migraine back under control. This is common. Migraine can frequently be triggered by loud, busy, noisy places, (visually provoked migraine) hence your problem in bars and clubs. (Although this can also be true of an inner ear disorder) Your trouble with flashing lights is often common with a migraine disorder - it can also trigger migraine. You are probably aware from reading the board of a condition called MAV (migraine associated vertigo) where people experience continuous dizziness as their only migraine symptom, without any headache.

The last thing is the hyperthyroidism and the fact those drugs helped. In your shoes, first and foremost I would want to check you are on the right dose of the meds. As far as I know (and I know far less about thyroid disorders) sometimes this can cause dizziness and vertigo and if you aren't on a high enough dose of meds that could be a problem. My brother's g/f has this condition and she was on the wrong dose of meds and had all sorts of problems until they upped it. It's also possible that if you have either migraine or an inner ear disorder then the thyroid condition is adversely impacting on that and stopping you getting better.

So what should you do? Well, in your shoes, as I said, first off I'd check the thyroid meds. Then, it would depend. If you have funds/insurance I might be inclinded to try and see a neurotologist to establish is this is an inner ear disorder or MAV. If seeing a neurotologist would be a problem, (financial etc..) due to your success with the paxil, I might be inclined, before seeing a neurotologist, to either go back on it and up the dose, or, if you hate the side effects try another drug from the same SSRI family. It's really a question of why the paxil worked, if it was managing the anxiety caused by the inner ear disorder then you'd need a different SSRI. If it was controlling a migraine problem then there are a whole plethora of daily migraine preventatives you could try which the neurologist could help you with, most of these aren't anti anxiety meds but special migraine meds. A lot of people who have MAV can only get it under control with a daily migraine preventative. Some people do try changing their diet to a migraine diet, I did this and it helped me. There is a book by Buccholz called 'Heal Your Headache' which gives more info on that.

To be honest, whatever, I would definitely banish any notion of being averse to drugs and feeling like you need to tough it out. This is all very well for a healthy person with the odd headache or ache and pain, or someone with the odd, infrequent panic attack, but you now have a vestibular disorder of one description or another. Diabetics don't tough it out without their insulin, asthmatics can often only function with the help of their ventolin inhalers, drugs can be a good thing. They are there for a reason. There is no virtue in being drug free if it keeps you ill.

I wish I could be more specific, but no one will be able to diagnose you over the net, but for what it's worth, if this isn't down to your thyroid, then I'd be willing to put money on this either being an inner ear disorder (most likely vestibular neuritis) or migraine associated vertigo. All the stuff you say, the problem in loud, busy bars, exercise induced dizziness, feeling of motion after stopping are all possible with either disorder. Basically something is messing with your vestibular (balance) mechanism. The ear popping you describe and weird sensations with your ears are also possible with both disorders. With migraine, often the only way to find out if you have this is if you get well with a daily migraine medication. There is no test that can prove someone has MAV. So even if you see a neurotologist they might not be able to tell you for sure which condition it is. It's often a case of trying the drugs and seeing if they work.

Hope this helps,


Kirb0 12-15-2005 12:16 PM

Re: stop me if youve heard this one...bppv or migraine?
Thanks for the responses.

What kind of daily migraine medication should I be trying to get?

Kirb0 12-15-2005 01:47 PM

Re: stop me if youve heard this one...bppv or migraine?
I forgot one other question...since the noise is an obvious problem with the migraine and thus the dizziness, do you think it could help in any way to invest in some noise reducing earplugs or just plain old cotton or something? Because I have trouble even going to movies now...whenever a deep bass line at a theatre ends and goes to silence, it sends me off. I had actually been wondering for a while now if getting some earplugs to wear into a movie would be worth it.

One other thing I will toss along...whenever I am watching a movie in a dark room and something on the screen is setting off my dizziness, I find a lot of times it helps a great deal just to cover up one eye so the impulses sent to the brain are cut down.

adamw 12-15-2005 06:16 PM

Re: stop me if youve heard this one...bppv or migraine?
Hi there

hbep has put together an excellent post above. I had something I thought I should add.

When I read it, it struck me as obvious that you may be confusing near-syncope (feeling faint, syncope is actually fainting) for vestibulopathy.

My first question would be - have you ever actually fainted and fallen? I would suggest, if this is not the case, that you are not experiencing a cardiovascular symptom (ie. syncope). If you have felt this way so many times, yet never fainted, it is almost certain that this is not your problem. Also, keep in mind that vestibular symptoms and syncope are not related in way - many people with vestibular dizziness talk about "nearly fainting" but never do - because they are more likely experiencing anxiety or vestibular dizziness or both.

I have had this sensation myself, and the best thing I have found is to stay as calm and relaxed as possible during this - you are not going to black out, and nothing is going to happen. It actually resolves much quicker this way.

Some will say that a response to an SSRI indicates that your problem is anxiety, but this is rubbish. These sorts of drugs have so many diverse actions that even a complete understanding of their pharmacokinetics gives NO insight whatsoever into why it is helping.

You really just need to do what works for you - you could try some different migraine preventatives that don't have the unpleasant side effects of SSRIs - there are tons of choices - beta blockers, calcium channel blockers, anticonvulsants and more.

It is more than possible that it is migrainous, but you will just have to do what works for you (ie. take whatever you need to, to function properly) until such a time as all gene mutations causing migraine are found (many have already) and can be reliably tested for - that day is not far away.

If you are really worried about the feeling of near-fainting, you may want to have a tilt table test - this is a great test in differentiating near syncope from vestibulopathy.


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