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  • Link Between Recurrent BPPV and MAV?

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    Old 01-19-2009, 05:23 AM   #1
    ssdizzy
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    Link Between Recurrent BPPV and MAV?

    Scott (or anyone else) - I thought I had remembered you posting something about a link between recurrent BPPV and Migraine at one point ... do you have any info you can point me to??

    I went through a year of recurrent BPPV (10 or 11 episodes) and feeling off balance, fatigue and brain fog in between episodes. At about the one year mark - they stopped! I had about 9 months of no episodes and much overall improvement. However, since October, I've now had about 4 or 5 BPPV episodes. And, some of these most recent episodes have been in my OTHER ear as well!

    So - I'm now back looking for possible answers .... I'm considering seeing if I can make an appt. to see Dr. Hain - I'm thinking the info you had posted previously was info from Dr. Hain but it's been a while and I don't remember for sure...

    Thanks!

     
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    Old 01-19-2009, 04:11 PM   #2
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    Re: Link Between Recurrent BPPV and MAV?

    Hi ssdizzy,

    Yes, migraine and BPPV are highly comorbid. That paper (an epidemiological study) you are referring to found that idiopathic BPPV was associated with migraine far more than any other condition.

    Epidemiology of benign paroxysmal positional vertigo: a population based study

    M von Brevern, A Radtke, F Lezius, M Feldmann, T Ziese, T Lempert, H Neuhauser
    J Neurol Neurosurg Psychiatry 2007;78:710715

    Notes from the article:

    We found the strongest association for BPPV with migraine. This association has been described previously. The frequency of migraine was 3X higher in idiopathic BPPV than in BPPV secondary to head trauma or surgery. Another study found that the prevalence of migraine in patients with BPPV was twice as high as that in age and sex matched controls. The relationship between migraine and BPPV is poorly understood. It has been speculated that migraine could cause vasospasm of the labyrinthine arteries, leading to detachment of otoconia from the utricular macula.

    If you hunt around you can find the full free version of the paper out there. It was the study that finally made me realise that I was a migraineur. I've had two BPPV attacks in the last 5 years.

    Best ... Scott

     
    Old 01-19-2009, 05:00 PM   #3
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    Re: Link Between Recurrent BPPV and MAV?

    Thanks Scott! I'll see if I can find the full article somewhere. I was happy to find out that Dr. Hain does phone consultations. I've made an appt. for a phone consultation in February - I'll be curious to see what he has to say.

    Thanks again for your help!

     
    Old 01-19-2009, 05:18 PM   #4
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    Re: Link Between Recurrent BPPV and MAV?

    Hi ssdizzy,

    Great news re the phone consult. I'll be very interested to hear what he has to say. Do you have other symptoms that could be migraine-based?

    Scott

     
    Old 01-20-2009, 03:37 AM   #5
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    Re: Link Between Recurrent BPPV and MAV?

    It's hard to say - this has been such a long, crazy journey and I have had a wide variety of symptoms kind of come and go. I do have pretty constant tinnitus and some visual issues still. I also get fullness/irritation feeling in my ear at times. I also had that zapping/buzzing feeling for quite a while about a year ago. I don't know. I read the Heal Your Headache book a while back and some of it seemed like it could apply to me - but not an exact fit. It may be a stretch, but I definitely seem to be outside the "norm" for BPPV with the number of episodes I have had and the fact that I now have it in both ears - so I'm ready to try to look for some answers again.

    Thanks again for your help. I'll keep you posted!

     
    Old 01-20-2009, 03:23 PM   #6
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    Re: Link Between Recurrent BPPV and MAV?

    One last question are you sure you've been getting hit with BPPV? I've had BPPV and certain dizzy attacks that were strictly MAV that very closely mimicked BPPV. In both cases there was nystagmus and my eyes were pulsing in a discrete direction although not as clearly as in the BPPV attack.

    The only way I was certain it was not BPPV was when I ran through the MEP. The different positions caused and increased spin, followed by a decrease (fatigue) and then it would completely stop when it was BPPV. Migraine type attacks were not affected in the same clear way by positional changes during the MEP.

    The other reason I am wondering about your BPPV dx is because of it occurring in both ears. That is really unusual as far as I know and seems unlikely. But who knows with this junk no two are alike.

    Scott

     
    Old 01-20-2009, 04:38 PM   #7
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    Re: Link Between Recurrent BPPV and MAV?

    I agree. I definitely think it's unusual to have so many recurrent episodes AND in both ears. That's why I want to start looking for other possible answers - maybe there's some other underlying condition that's triggering the crystals to move?

    I'm pretty confident the episodes have been BPPV. I have been treated in the dr.'s office with the infrared goggles and even a few times in the Epley chair and it was clearly BPPV. Also, when I have done the MEP, the response has been classic BPPV.

    I only discovered that I had BPPV in my "other" ear recently (right ear) during a treatment in the Epley Chair. I couldn't figure out why I couldn't clear it myself with the MEP, so I made an appt for the chair. It turns out it was my right ear - I never bothered to even test my right ear because for the previous 2 years it was always my left ear! At least that helped explain why I couldn't clear it myself - I was doing the Epley for the left ear!

    I have been lucky enough to have about an 8 or 9 month reprieve from these episodes and my other dizzy symptoms have gotten much better. I have been at about 98% on a daily basis. Most recently, I've had about 4 BPPV episodes since October. The good news is that now I bounce back within a day or two .... so at least I'm much better than I was even a year ago.

    Hopefully I can get some answers as to why this keeps happening (if there are any!!)

    Thanks again Scott!

     
    Old 02-06-2009, 02:29 PM   #8
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    Re: Link Between Recurrent BPPV and MAV?

    Hey Scott -

    Just wanted to give you an update and let you know I had my phone consult with Dr. Hain today. He thinks there are two possibilities behind my recurrent BPPV - either Migraine or possibly Hydrops. He is suggesting Topamax for the migraine and he is also suggesting I get an ECOG test done to rule out the hydrops possibility. Apparently many of my symptoms (besides the recurrent BPPV) are classic MAV.

    It's nice to at least have some answers. I had gotten to the "I guess I'll just have to live with this forever" point - always waiting for the next crystal to move! Now it's nice to know that there might be some help for me out there.

    Dr. Hain was great - He spent probably 30-40 minutes with me on the phone and was very patient and answered all the questions I could think of.

     
    Old 02-07-2009, 01:14 AM   #9
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    Re: Link Between Recurrent BPPV and MAV?

    Heya,

    Great news! I thought he'd diagnose MAV. Very common and a big cause of BPPV. You'll probably find it's not hydrops. I don't know anyone on mvertigo that ended up with hydrops. I think it's rare but definitely worth ruling out.

    Were there any other gold nuggets of info he mentioned that you weren't aware of? I always hear great things about Hain ... definitely very nice to talk to. Maybe I should have a consult with him although I'm not sure there's anything else he could say that I haven't already heard. It would be more about the drugs to take and coming up with a better plan. I'm currently mucking around with pizotfen.

    Keep me posted on your Topamax trial!

    Best ... Scott

     
    Old 02-07-2009, 05:38 AM   #10
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    Re: Link Between Recurrent BPPV and MAV?

    Nothing else too profound - it was just so nice to have someone validate the fact that all these things happening to me were related, the number of BPPV episodes was way out of the ordinary, and that they can be treated. My other doctor just basically said - it's BPPV and it could keep recurring or it could just stop. That didn't give me much hope.

    Dr. Hain made me feel more hopeful than I have in years because he went thru the potential treatment paths for hydrops, migraine and BPPV and he even had a worst case "end of the road" treatment for BPPV (surgery) and hydrops. That made me feel like there may actually be an "end" to all this.

    It was interesting because I felt like here was this opportunity to ask him any question - but I couldn't think of too many because he had already given me a pretty clear explanation and treatment path - and he seemed very optimistic about it too.

    I'll keep you posted on how things go. He said that I should know if the meds are working within a month or so. I was prepared for a long trial and error path with the meds and he seemed to think that whatever med I chose (out of the three he recommended - Topamax, verapramil (sp?), Effexor) there's a very good chance they are successful on the first try. I'm keeping my fingers crossed!

     
    Old 02-08-2009, 04:12 PM   #11
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    Re: Link Between Recurrent BPPV and MAV?

    Hey ssdizzy,

    There's another paper I forgot to mention that covers the studies showing the link between migraine and BPPV. It's from Baloh's group:

    Migraine Associated Vertigo
    Yoon-Hee Cha MD, Robert W Baloh MD
    Journal of Clinical Neurology/Volume 3/September, 2007

    In summary:

    Several studies have shown high prevalence rates of migraine in idiopathic BPPV. A retrospective study by Uneri in 476 patients with posterior canal variant BPPV revealed a history of migraine meeting IHS criteria in 54.8% of patients; 67.4% of these 476 patients reported a history of motion sensitivity, both rates that are much higher than population baseline. Ishiyama et al. studied 247 patients with BPPV and found that a history of migraine was 3 times more common in patients with idiopathic BPPV than in those who developed it after head trauma or surgery. Von Brevern et al. performed a population based study of patients with dizziness/vertigo using historical criteria for BPPV (at least 5 attacks of dizziness triggered by typical head position changes lasting less than 1 minute). These studies indicate that migraine is a risk factor for BPPV. Though the mechanism is unknown, it may relate to small degrees of ischemic damage to the otoliths, perhaps through vasospasm.

    Best ... Scott

     
    Old 02-09-2009, 04:28 PM   #12
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    Re: Link Between Recurrent BPPV and MAV?

    Thanks Scott! That's very interesting ... and it definitely seems like I am falling into that group. I'm hopeful that means I'm on the right track and the meds will make a difference.

    Thanks again for all the great info!!

     
    Old 03-10-2009, 11:17 PM   #13
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    Re: Link Between Recurrent BPPV and MAV?

    How much did it cost to talk to Dr. Hain over the phone?

     
    Old 03-10-2009, 11:27 PM   #14
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    Re: Link Between Recurrent BPPV and MAV?

    Hi Emma,

    I phoned their office two days ago. The cost is $US350 for the first consult. They want your medical records and you'll have to fill in a few forms.

    Best ... Scott

     
    Old 03-13-2009, 08:53 PM   #15
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    Re: Link Between Recurrent BPPV and MAV?

    Hey Scott,

    Did you talk to Dr. Hain? I have a consult with him next week. I got so stressed out from taking the Topamax and feeling hopeless I came down with the shingles today.......................Let me know how you are doing...

    Emma

     
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