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Doctors' Answers to "Frequently Asked Questions" - Vertigo

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 07/7/2000]

Answer: I would see a dermatologist about the skin and ensure there is no problem. I would find another treatment rather than the transderm scop, like antivert that you can alternative occasionally. I assume you have had some diagnostic testing for the vertigo. Continual vertigo is unusual and needs some formal testing.

[posted 02/3/2000]
Question: Hi.

After discussing chemical ablatement of the vestibular nerve on my right side (Gentemyacin shots), the ECOG test showed .59 IN BOTH EARS thus nixing the idea of chemical (or surgical) ablatement.
Currently the Ativan 1mg is really helping by completely stopping the whirling vertigo attacks and greatly reducing the motion sickness I feel when walking (okay, I'll be honest, I don't walk, I stagger)

Currently I get vertiguas attacks that last 1-2 days with a freww period of a day or two. These attacks get worse over time until they last 4-5 days. things then seem to get back to normal (but not such a ridged scedule). I'm to use the ativan as needed for the vertiguas attacks until vestibular theropy has had a chance to work.
My doctor made it clear that he would consider permitting me becomeing physically additing to ativan if the physio theropy fails (he feels it will, it only helps in less than 20% of these severe cases, but I would rather it succead).
So I have two questions:
1) The manner I'm now taking Ativan 1mg - 1-2 a day for a few days then a day or two off and then back to drug. Will this still cause addditcion? That is, is this givving th edrug enough time to leave my system before I reintroduce the drug to myself?
2) what does long-term addition to this drug mean for me?

Thanks for any light you can shed on this unpleasent topic!

Answer: You will probably become somewhat addicted if you are taking this level. But, so what if it is necessary for normal functioning?

[posted 01/15/2000]
Question: 3 times in the last 6 months I have experienced Labrynthitis. The symptoms have kept off work for about 2 weeks each time.The last attack has left me feeling really shakey. I am told it is a viral illness and hence only the symptoms can be treated. I think it is viral as my 9 year old daughter has experienced the same symptoms and also one co worker. I would like to take a pro active approach how do I begin ?

Answer: There are some exercises that your doctor/ENT can show you that tend to decrease the frequency/severity of the vertigo that you are experiencing. Other than that, no new treatments on the horizon other than symptom control with meclizine or equivalent when it occurs.

[posted 08/16/1999]
Question: I am 32 and have been told that I suffer from Vertigo. (by E.R) I do not trust my doctor to treat this problem and have not seen him about it. Don't get me wrong, I just get the feeling that he is just your basic doc. Help a cold, cure an infections. What I need to know, is there an O.T.C. that I can use to help releave this problem until I find a treatment? I am looking for any help you can give me. Not it matters I also have C.P.

Answer: Antihistamines(benadryl, chlortrimeton and the like) are the first line of treatment. We usually use a drug called Antivert, but similar in effect.

Marijuana Use for Vertigo [posted 10/28/98]
Question: I have had vertigo for many years. I have been told that there is nothing that can be done for it. I was taking dramamine but I would still have bouts of dizziness. I have ringing in my ears and I get motion sickness very easily. I recently was prescribed valium at 2mg twice a day. The dosage is to be increased slowly. I have only been taking it for a few days. It hasn't helped yet. I saw another doctor and he said there was nothing he could do but he was totally against me taking valium. I don't know what I am supposed to do. When I was younger I was dizzy and sick to my stomach, vomiting, and I was told that I was faking it. I was given a placebo. I have had to learn to live with it. I noticed when I felt dizzy and sick to my stomach and I smoked marijuana that I felt better. Of course there has been no real research done on marijuana's effects. But I know that my symptoms are lessened after I smoke. Sometimes the symptoms are too severe and I vomit anyway. But most of the time it stops the nausea and I can go about living a pretty normal life. My boyfriend thinks that I am smoking pot just to get high. He thinks there is no medicinal value to it. I have tried not smoking pot and the nausea gets severe enough that I can't eat and the dizziness turns into vomiting. I can not enjoy a normal life. I have read that there is no real way to cure vertigo. I would like to know the best way to handle the symptoms. I have tried dramamine and it isn't working. Is there anything that can get rid of the symptoms? Is there any research conducted on vertigo/dizzines with marijuana as medicine. And what can be done about living with vertigo?

Answer: Well, first you need some more tests. MRI of the brain otic nerve etc. Second, there are different medications that work including anti-emetics used in chemotherapy. These are generally better than marijuana. Although, there are some patients who only respond to marijuana. There is a synthetic marijuana available by prescription and oral marijuana would avoid the tar and lung cancer risk (one reefer equals one pack of cigarettes in general). Have you seen a specialist?

Migraines / Vertigo [posted 8/13/98]
Question: I suffer from both migraines and vertigo. 3 years ago, my doctor at the time said that these two things were related. They both come and go at different times. Sometimes I'm dizzy for 2-3 weeks and I may or may not get a migraine during that spell. Are these two things really associated? My current doctor just hems and haws when I mention them. I'm taking duradrin and imitrex for migraines and meclizine for vertigo.

Answer: They can be if the migraine vasospasm affects the area of the brain that is responsible for balance, etc. However, this is not common. You can test this very easily. If you have onset of a migraine and vertigo, relief of the migraine with Imitrex should relieve the vertigo if they are related. However, more commonly, they are unrelated.

Vertigo [posted 8/10/98]
Question: What is the treatment for persistent Vertigo? What, if any, would be the best or most common drugs to prescribe?

Answer: In general, there is no drug cure. Drugs are used to treat the symptoms. Any of the drugs which have anticholinergic activity will be useful. These are the antihistamine class in general and drugs like Antivert (meclizine), Atarax, etc. The most common drug is meclizine, mainly out of habit.

Vertigo [posted 8/6/98]
Question: I have been experiencing Vertigo for more than a year and a half. I have been diagnosed that the cause is from my inner ear. I have been to the General Doctor who referred me to see an ENT, since as a child I have always had ear problems. The ENT tested me every way imaginable, MRI, ENG, and ABR. Unfortunately they were unable to pinpoint which inner ear I have the problem with. They put a tube in my right ear, which I still have and prescribed me medication for the dizziness, which did not help? I have just been trying to deal with it? Recently, I have been feeling some eye strain and pressure with the vertigo. (I normally experience vertigo laying down, but now its happening all the time) and yesterday I went back to the ENT. At that point the doctor basically told me, there is nothing he can do for me. No sense in prescribing me anything because the medicine doesn't work and to just continue my 6 months check up. I have been given "Balance Improvement Exercises" (i.e., Eye exercises, head exercises, sitting, standing and moving about) and wonder if anyone has had success with them? I have also been told to cut down or avoid high cholesterol foods such as meats, Pork, Sausage, Eggs, Bacon, and Cream. I also wonder if this could be caused by stress? Also, I have been rear ended 3 times in the past 6 years, could this have been a possible cause of my vertigo? I do feel certain pressure or tenseness to the back of my neck and my head feels much better when I am massaged at the back of the neck. I really don't know what to do. I feel as if I am going crazy.

Answer: Vertigo is both very disabling and very difficult to treat. Most of the vertigo is treated by symptomatic relief - not addressing the underlying problem. That is because we really have no idea as to the cause in the great number of cases. There are many things that can trigger vertigo, including a motor vehicle accident. However, the greatest number occur without clear cause. We have a long list of treatments - none seem to work very well except time. Meanwhile, the patient feels horrible, often is nauseous and has great trouble functioning. The exercises you are doing are the only thing that I have seen with any effect what so ever. Good luck.

Vertigo and Serzone [posted 7/23/98]
Question: For 2 months I have been having headaches, as well as loss of balance, and feeling of confusion, as if I am drunk or stoned. It just began one evening with the loss of balance, and has progressively gotten worse since. My family physician has prescribed Serzone for me, and as of today, I have been on the drug for 5 days. Do you have any idea what may be causing my problems? I have had my blood tested, and there are no signs of infection or tumors. Also, do you think the prescribed medication will help? I am 21, and a fairly active student who eats healthy and does not smoke or drink.

Answer: Vertigo is a complex problem. Unfortunately, due to the high voltage and small size of the vestibular apparatus, it is poorly known. Diagnosis and treatment of different states that cause vertigo are really pretty primitive. The options for treatment really haven't changed for 30 years. There are basically two types: benign and central vertigo. Benign will go away, although may be episodic for several years. Central will not and usually progresses. Except for x-rays to rule out tumors in the brain there is precious little that can be done. Serzone is to treat the symptoms (like most treatments for vertigo), but will do nothing for the cause.

Question: I am 38 years old. I was bitten by a dog approximately 2 weeks ago and was given a course of augmentin 625 mg and flagyll 400 to prevent infection. Two days later I developed a rash, and I developed severe vertigo with accompanying tinnitus. The first doctor that treated me initially diagnosed that I was allergic to one or both of the antibiotics. The last doctor that treated me thinks that it is just a normal ear infection. Is it possible that the vertigo could be caused by an allergy to one or both the antibiotics?

Answer: Unlikely that it is the allergy, but it is possible-- especially if there is any element of vasculitis. A more important question is if it goes away. Also, did the MD see any redness or distention of your eardrum? If so, then I'd assume that it has nothing to do with your allergic reaction.

Question: I recently got jolted on the side of my head and got whiplash. Over the past three days it has improved to a mere ache at the top of my spine when I sit still for while. Today, I was dizzy when I went to bend down and get something. The sensation did not stop like normal dizziness would. When I looked around the room or moved at various times I would get the dizzy sensation again. I was going to the doctor's office for another reason (anemia) and told my doctor about this. He checked me and said it was probably vertigo. When he checked me laying down (changing position) he was able to see I did have some slight vertigo. He said this was totally unrelated to the head injury and just coincidental. Do you feel the same or do you think a slight jolting on the head could result in some slight vertigo?

Answer: Probably related to the trauma.

Question: I am presently taking one hismanal tablet daily for positional vertigo. Is there any other kind of medicine or cure that you know of ? I am somewhat satisfied with this medication, but I continue to suffer with vertigo from time to time.

Answer: Hismanal is not one that I would usually start with. This is because it is a semiselective antihistamine and enters the CNS at about 1-5% of more traditional antihistamines. Since the cause of your vertigo is in the brain, this doesn't make a lot of sense. Either use more traditional antihistamines like benadryl, etc... or drugs like Antivert(meclizine) 12.5 or 25 mg 3x a day.

Question: I am 65 years old and have been experiencing fairly severe dizzy spells for the past year. At first it actually affected my walking, but now it's mostly when I am looking upwards, or getting into bed facing up. After a car or bus ride I sometimes stagger when first walking. About 6 months ago I had a head scan that showed a possible infection in a canal associated with the ear. I took full dose of prescription antibiotics and nose spray, but it fix the problem. My doctor said he could refer me to a eye, ear, nose specialist, but wasn't very optimistic about their chances of fixing the problem. What could my problem be? Are there any remedies or do you have to live with it? How do you tell the difference between a common balancing problem and something more serious?

Answer: There are tests which will decide if the problem you are having is in the inner ear or central in the brain. For practical purposes, a CT scan will usually find the central ones, but not always. A good lay test is to see if it extinguishes. That is, if an activity produces the vertigo keep repeating it. If the vertigo slowly gets less this is almost always a benign process.

Question: For over a year, I have experienced vertigo, dizziness, fullness in both ears, and clicking in my left ear (like a telegraph key). I have had MRI, seen neurologists, ear doctors, and an internist. This condition comes and goes, over several months. Is it Meniere's? I also get fluttering in my heart when this comes on. Driving is scary as I feel disoriented and not in control. After the dizziness, I have a low grade headache for several hours and no pills help. What can be done?

Answer: Continued vertigo is both disabling and a medical challenge. That is because, except for a few minor diagnosis, there is little to be done except symptom relief. The middle ear is too small to perform any operation on and we don't have any medications to treat either vertigo or tinnitus. Meniere's syndrome is technically defined as vertigo (dizziness), tinnitus (ringing in the ears) and progressive deafness. In the early stages of the disease not all of these may be present, but will be present as the disease progresses. Currently, it does not sound as if you are experiencing either tinnitus or progressive deafness, so at this point do not technically have Meniere's Syndrome. Also, the irregular heart beat during these spells is very unusual. Has your blood pressure been checked during a spell? Also, I would get an event Holter monitor to determine the nature of these cardiac irregularities. These both may be a waste of time, but you need to look for causes outside your ear since treatment of ear disorders are rarely effective.

Question:I have an elderly friend that has vertigo. Been to about every kind of doctor. Can't get relief. No eye problems tumors nerve problems. Any suggestions?

Answer:Vertigo is one of the more frustrating and difficult medical conditions to diagnose correctly and to treat. Since I am a fellow sufferer, I have kept up with the vertigo literature and been to several labs to elicit my cause. Like most, no treatable cause has been found. If the vertigo persits, is incapaciting or increasing in severity an evaluation is necessary. This will start with a CT of the brain and possibly a hearing evaluation. There are laboratories dedicated to evaluation of vertigo. The basic question is to establish whether the vertigo is peripheral or central. Peripheral means the ear and balance mechanism is causing the problem. Central means a disorder in the brain itself is responsible. A good rule of thumb is whether the vertigo can be extinguished. This means that the manuevers which produce vertigo-if repeated over and over-produce less severe vertigo with each attempt. This means that the vertigo will be classified "benign";that is, not caused by neurologic diseases or cancers. Treatment of these is centered on minimizing symptoms since the cause is usually not clear.

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