Vertigo, Redux

I haven’t posted for a while not because I was on a restful summer holiday but because I’ve been experiencing bouts of vertigo and dizziness over the past few weeks. Not only do these sideline me, they also affect my brain.Vertigomovie_restoration

They affect my memory, for starters. As I began to write this post I did a quick Google search and discovered that I wrote the exact column I was thinking of, under exactly the same title (“Deaf and Dizzy”), a year ago. If you want to know more about vertigo, Meniere’s and migraine-associated vertigo (MAV), you should read it. (My diagnosis is MAV.)

Memory loss is just one of the ways vertigo and dizziness mess with your head. During acute attacks, which in my case last for a couple of hours, I have to lie down with my eyes closed. If I open them a crack and see the room still spinning, I shut them again. If I don’t lie down soon enough, I vomit. Even sitting is no remedy. I have to lie prone.

In between acute attacks I’m dizzy. I walk unsteadily and sometime lurch, depending on the intensity of the dizziness. I look like a drunk. It’s not just memory that suffers. The brain seems generally confused. I pour orange juice into my coffee. I try to unlock the front door with my car key. I worry it’s a precursor to dementia but my doctor assures me it’s not.

I can’t detect a trigger for my vertigo, but luckily I recognize the symptoms of onset and can try to get to a safe place before it hits me flat out. For a few hours or even days preceding an attack, the back of my neck aches and the ache gradually spreads upwards. I feel pressure in my left eye. I experience hyperacusis. I may be a little dizzy. I’m tired. But it’s when my eyes swing to the right and the world starts spinning counterclockwise that I know I’m on the edge of vertigo.

Sometimes, the timing is not only inconvenient but dangerous — usually when I’m driving. Before and after a full attack, I can focus on the road ahead and make it to a safe place. Interestingly, focusing on one point is recommended as a way to control vertigo. I couldn’t possibly drive during a full-blown vertigo attack, but experience has shown me that I can get to safety — through what feels like force of will.

Alan Desmond, who writes the blog “Dizziness Depot” on Hearing Health and Technology Matters and is the director of the Vestibular Audiology Program at Wake Forest University, was hit with an episode of vertigo himself recently. He described how he used that focusing technique, training his eyes on a doorknob. I doubt he would ever endorse focusing on the road from behind the wheel of a car as a cure.

I watch my diet. Migraine-associated vertigo, also called vestibular vertigo, is triggered by many delicious foods, among other causes. The Meniere’s Diet is similar. If you look at the list at the banned foods, you may wonder if there is anything you can eat. The Vestibular Disorders Association recommends avoiding red wine, chicken liver, smoked meats, yogurt, chocolate, bananas, citrus fruits, figs, ripened cheeses (for example,  cheddar and Brie) and nuts. All these foods contain the amino acid tyramine. The association also recommends avoiding caffeine and alcohol. Sometimes salt intake is restricted. Aged meats are easy to avoid. Caffeine is not.

Like many with vertigo, I take preventive medication. For me it’s been a small dose of the tricyclic antidepressant amitriptyline, the generic for Elavil. (The dosage is much lower than would be used to treat depression.) That dose clearly had stopped being effective, so now I am taking a larger dose, still well below the antidepressant level. The fact that I’m writing this is an indication that the brain fog is starting to lift. I’m also signed up for vestibular therapy, which is a big commitment of time. But if it works it will be worth it, and I’ll be able to go off the medication.

The biggest mystery to me is that every doctor I have consulted – two neurologists and three balance specialists – says that my vertigo is not related to my hearing loss. I do not have Meniere’s Disease. I have migraine-associated vertigo (MAV) or vestibular vertigo.

MAV is only recently defined and was frequently misdiagnosed as a variant of Meniere’s in the past. The overlap between the two is substantial, and a review study published last year in the journal Behavioral Neurology, comparing the “intimate relationship” between migraine-associated vertigo and Meniere’s, suggests that the underlying causal mechanism may be the same for both conditions. I’ll discuss that study in my next post.

I’d like to know how others handle vertigo. Please comment. We can all learn from each other’s experience.