Monday, 20 December 2010

Link between Migraine Associated Vertigo and Psychological triggers

Taken from my own medical report by a Consultant Neuro-tologist

She told me she felt as if there is a trigger in her brain with a simultaneous onset of her abdominal symptoms. She told me that she had undergone several endoscopies and several biopsies without a final diagnostic formulation. She continues to experience episodic symptoms of headache, nausea and dizziness followed by a sensation of feeling “numb”. I asked her what she meant by this. She described an emotional blunting and off balance sensation. With these symptoms she often has discomfort deep in both ears. She has a background sensation of imbalance which compromises her ability to exercise. She has find that many exercises trigger her nausea and headache. She has a documented peripheral vestibular lesion and he has been prescribed the vestibular rehabilitation exercised by VRT Physio, but she probably does not practise these as often as she should. She spends much of her time working with a computer running her business. She has found that using computers for long periods aggravates her symptoms.

This complex medical history raises in the differential diagnosis a migrainous and autoimmune association. The visuo-vestibular projections to the hippocampus, Papez circuit and neighbouring areas would account for the overlap between the vestibular and psychological aspects of the presentation and the response to xxxxx
This NT will be referred from now on as Dr Wonderful
This for me was a very important step towards understanding the condition and validating some of the ways I was treating my MAV without realising it. I will refer back over and over again to this since it is pivotal in later understanding the triggers and how the link back to Vestibular Problems.

The VRT part is also important since I at the time after spending months with no improvement with VRT had started to develop better treatments through trial and error by focussing on the psychological triggers prior to this report.

Unfortunately after seeing a member of desperate to understand the link between anxiety and dizziness  and obviously needing some support and witnessing the tired drivel from the admins of the site I posted the medical evidence above. The admin deleted the post but still left her own "opinion" unchallenged. Their "expert" then posted asking what evidence do I have to demonstrate a link between psychological conditions and dizziness. I am not sure how far the term expert extends, I can understand this I am sure anybody else could even without "medical training".

Unlike I am not going to offer medicine advice (since it is rarely the answer), but I will be posting many of the complimentary therapies which really help and how they work. If you are desperate and want to talk to someone then please just contact me through this blog. I can give you the names of real medical experts who I respect and admire for what they do to help people with this disorder. There is alot of mis-information on the web, there is also lots of useful information, my advice is to challenge everything but discount nothing. It was my persistence that paid of in the end because of the poor primary medical support I received.

This is not the full explanation, but merely an important relationship established. There are many more important interactions which I have understood as my experience of the disorder developed. The body is a system with many functions. You cannot have a problem with one part of the system and not impact it elsewhere. I will try and communicate my observations about these interactions later so you can maybe challenge whether you think it's nonsense or not. Please do since I like some lively debate. I will publish a comment no matter what the content as long as it's relevant and does not hurt anyone.

Final Rant about Dizzytimes (on this post): Why when a forum which has maybe thousands of posts querying the link between anxiety and dizziness do the moderators immediately discount a link between the Psychological triggers? Why do they then delete without consultation the first evidence of such a link? Why do they instead promote disorders instead which are unverifiable (medically documented as being so)?

Even More Evidence

CONCLUSIONS: Vestibular disease and psychiatric disorders are the most common causes of persistent dizziness in outpatients. In about 50% of patients with dizziness, more than one factor causes or aggravates symptoms. Life-threatening causes were rare, even in our elderly population.
Unifying theoryBoth vascular and neural influences cause migraines.
1.stress triggers changes in the brain2.these changes cause serotonin to be released
3.blood vessels constrict and dilate
4.chemicals including substance P ir
Comment: This unifying theory is similar to my own but mine varies due to the fact I believe a Vestibular Migraine is different from a Classic Migraine. More later...

Stress, anxiety, hypoglycemia, fluctuating estrogen, certain foods, smoking, and other factors can trigger migraine. Vertigo and imbalance secondary to migraine usually respond to the same treatment used for migraine headaches. Treatment of migraine includes eliminating from the diet substances known to trigger migraine attacks, such as chocolate, nuts, cheese, red wine, and other foods. Medications may also be prescribed.

I challenge the Dizzytimes Community Advisor to comment here and ask again what evidence do I have that Anxiety/Stress is a contributor to Dizziness.  Stress is the trigger, it took me a long time to understand what stress is at a neurological level, but given that my GP could not be bothered to read up about it I had no choice.

NB. I would strongly advise those with BPPV and Labyrinthitis diagnosis to consider whether Compensation Pain might just be Migraine Associated Vertigo (especially if you have had it for sometime).


  1. HI, just found you, very interesting stuff! I do think there is a link between moods and dizzyness, well with MAV anyway. I do not however think that 'anxiety' is a cause which my doctor believed and sent me to see a cognitive therapist, which caused me, in the end, to have a nervous breakdown. In the article you linked to the psychiatric causes ware fairly low compared to vestibular even though it was one of the main causes.

    For a year now I have been journalling, I have 3 journals, one for symptoms, one for ranting and exploring and one for art when I cant get the words out and this is what I found:

    I am angry and my anger was making things a lot worse and causing me to not be able to deal with my symptoms effectively. I believe that some of it is to do with my menstrual cycle, or lack of it, as I also believe this to be one of the many triggers of the migraines. Since journalling my anxiety levels have dropped but my dizzyness has not. I found the strength to exercise more, which also, so far, has not helped. (I have been exercising regularly now for 8 months). I think everyone's case is different and should be treated so. I think with me there are many answers some of them I didn't want to hear but through discovering them myself I found it a better way of dealing with my symptoms, as I feel in control.

    I wanted to see a counsellor as I knew, having seen one before, that I worked well with them and felt that they would be more effective. I think that there a many disorders where it helps to see a professional to talk to. But when it comes to chronic disorders that effect our brain that can be seen as an admission that its all in our head. Which is frightening, who wants to admit that? (I don't believe it by they way, I know it isn't just on my head) Maybe if my doctors had been more sympathetic to that and didn't just railroad me, things might have been different. A bit of empathy goes a long way.

    The being on the computer interested me also as I have been spending less time on the computer and have felt a difference, I am going to see an optician soon just to rule that out.

  2. I am building up to a much bigger conclusion which I don't want to reveal until I can clearly explain my reasoning supported by strong medical opinions from experts in the field. It is very complex and I need to bring many strands together in a way that people who have the disorder understand it.

    My episodes of MAV went something like this:

    1. Period of prolonged stress.
    2. MAV episode.
    3. Increased sensitivity (sound, light).
    4. Vestibular Compensation (Headaches the usual stuff).

    For a long time this pattern repeated without me understanding it until I began focussing on the sensitivity components. The Vestibular System has inputs from nerves in the body, the eyes etc. The Migraine was altering my interpretation of those signals making me "hypersensitive" to visual stimuli. My conclusion being that if the Migraine is changing how sensitive I am to light, it must be having a massive impact on the way the Vestibular System is working. Classical Vertigo Compensation theory goes that your Vestibular System will compensate for changes when one part of the system fails and it rebalances itself. I believe that Migraine Associated Vertigo once triggered interferes with the Vestibular Balance, leading to another period of Compensation. Since I have been through many episodes of this cycle I feel very comfortable with this conclusion.

    Overtime I developed problems not sitting at my workstation and eventually found out why. I don't want to again go into details but I believe (through personal experience) that MAV is associated with another condition which affects the nervous system and the musculoskeletal system. Sitting for long hours at PC causes muscles to spasm reducing blow flow to the nerves. I found over time that sitting at a workstation started to cause daily MAV episodes and chronic backpain.

    I having a theory on how people with MAVs vestibular Syetems become strongly sight dependent because of the way Migraines interfere with the way it can interpret the signals. In non medical terms the brain becomes more sensitive to light making it more biased to the signals. I am meeting my Neuro-Tologist (Dr Wonderful) tomorrow to confirm.

  3. That sounds interesting and quite exciting, I'm looking forward to hearing more about your findings as a few things you have said is very similar to my situation. It is nice to finally hear someone with some useful things to say, Thank you I really hope Dr wonderful backs up your findings. Its nice to hear that someone has found a decent doctor that understands.

  4. Thanks for your comments. I went to your Blog and saw you are unable to work. Thats terrible. I am sorry you are having such a tough time. I will keep in touch. Thanks for your comments. You said something really important above MOOD. Your are 100% correct. I will be blogging more about MOOD, specifically Dopamine. Please research Dopamine and how important it is to the balance system and your mood.