Migraine in Otolaryngology Part II, BPPV, Tinnitus, SSHL,Sinus Headache, Treatment

Migraine is a common problem experienced by a large segment of the population. The presence of migraine can mimic or accompany the presentation of common otolaryngologic complaints such as sinus pain, headache, otalgia, vertigo, aural fullness, and fluctuating hearing loss. Many patients experience migraine in ways that exacerbate symptoms from their otolaryngologic problems or suffer migraine symptoms triggered by their otolaryngologic problems and will benefit from migraine therapy. Unfortunately, only patients with severe or debilitating classic migraine tend to receive significant attention from their primary physicians or from neurologists who treat the majority of migraineurs in this country. This lecture will acquaint the practicing Otolaryngologist with an update on the association of migraine and BPPV, Tinnitus, Sudden Sensorineural Hearing Loss, and Sinus Headache, and will review sound treatment strategies for patients who have migraine headache or atypical otolaryngic manifestations of migraine.

Dr John Carey, at Johns Hopkins University made significant content contributions to this presentation.

[jedheart]

Yeah, definitely awesome public service. Have had so many CT scans, MRIs, Sleep Labs, EEG labs, this week an Audiology Vestibular lab which was like torture, especially the Caloric Test. I have been treated for Meniere's for over ten years. But the new Audiologist and new ENT wanted to rule ear crystals and Superior Canal Dehisance Syndrome. I had a Chronic daily Migraine starting at the top of my neck, bottom of my skull for five years in a row until my old Neurologist gave me Cyproheptadine over ten years ago. But then soon after due to allergies, I got a new Allergist back then. So, I started on several allergy and asthma medications. Immediately a lot of body pain besides arthritis shifting into tolerable except during weather changes. I have peripheral neuropathy from military injuries some decades ago. After all the antihistamines, I have not had an intense over top of neck over the head migraine. I had eye migraines for now over a decade. But, when I have had reactions to eating foods, I get electrical storms, like electrical shocks as if being struck by lightning for hours while also regurgitating food that won't digest - usually fat. Finally, a year ago, I had an urgent gallbladder surgery. But I had a reaction to the anaesthesia and medications. I was on strike alert for hours while I was unconscious for some right hours after surgery ended. I never woke from post op. When I woke, I could not move except for what they referred to as course tremors. I could not hold my phone to call home or lift my leg to get out of bed. I was stuck in the hospital for three days. I had to use a walker to leave the hospital. I had Sleep Labs for Sleep Apnea, Narcolepsy, Epilepsy. I have sleep related and seizure related symptoms. But my entire cascade of symptoms I have telling these doctors for since 2008, first started complaining about it in 1990, that all my symptoms are related. I had a reaction to a bone reconstruction surgery in 1987. And, all the symptoms began after that surgery. I always had motion sickness since childhood. I had migraines when I was a lifeguard in and indoor pool setting from the smells of pool chemicals I had to use when I worked. But that was the only time I had migraines. So when I had allergy tests, I have year around allergies - several lawn grasses, tree pollens and outdoor molds, not indoor or dust gratefully. Antihistamines are my saving grace. So, my ear symptoms which are constant tinnitus, war fullness, daily nausea due to bending or eating something disagreeable, ear fullness, ear pain during weather changes and wind, dizziness and at worst, vertigo with the walls of the room moving to spinning at the very worst. But I alleviate every bit but I can with Meniere's medication. It does not effect my ear fullness, war pain, tinnitus or hearing loss. But the Vestibular test this week ruled out my Ear itself. I was told my results is a "Central findings". She explained that it's higher up the chain and referred me back to ENT and Neurology. I have a University Medical Epilepsy Neurologist also. I keep telling everyone, for all these years that my symptoms are a cascade. One symptom leads to another. I know when I am going to have Nocturnal Seizures when my electrical storms begin with intense, louder and louder tinnitus, ear pressure and drops, atonic head or torso drops or hand and arm myoclonus. It's one thing right after another. Then I fall unconscious, while at my computer or after an evening meal, anytime in later afternoon if I am not getting enough sleep. I have to go to bed by 9-10pm nightly to avoid that cascade. I read years ago that Migraines might be related to Epilepsy. But after my Vestibular results, I started researching what my results mean. Since MS was ruled out over the years, that left Migraines. Reading about the latest research, I have become aware that a Hemiplegic Migraine could account for seizures. That makes sense. But why the ears? I watched Dr. T's Vestibular Migraine explanation. He definitely made the point to explain the potential for the Vestibular Migraine to be non-local in the brain, or maybe on the brain. I have a CT scan for Semi Canal Dehisance in a few weeks. Afterwards, I am going to be listening to what the ENT and neurologists tell me about my results and their opinions. But I am going to be asking about Migraines and Migraines with Epilepsy and Vestibular connections. In addition, I have had seizures with Migraine and Serotonin, Tryptans, Depakote, Carbomazapine, Keppra over the years. I can only tolerate Gabapentin and Benzo medications. Only 24 hours to up to a week on a new medication, I will have reactions, except Gabapentin and Benzo medications. I can have Lidocaine for procedures but I actually need more than average. I have tremors on Tramadol. I had taken Benzo medications for sleep over ten years ago but was worried I might need to wake up in case of an asthma attack at night. But I never actually had a reaction using it. Now allergies and asthma are maintained fault well. Topiramate gave me insomnia which I cannot tolerate because it Cascades my myoclonus when I don't get enough sleep. My Epilepsy Neurologist wanted to prescribe Clonazepam, I think it's that one, but the VA pharmacy said I had to trial the Topiramate first. My Epilepsy Doctor told me to stop taking it if I have a reaction. So, I am waiting for that appointment to. I will see her after the VA doctor appointments following my CT. Now, I have so much more awareness of how I need to prepare for those appointments. If my doctors know all this in some combinations between them all, they should be coming to some conclusive determination on what is going on with my Central findings. Thank you.

[ichbindarren]

This is pure gold. Thank you for making this available to us.

[lkas]

Thank you very much for this amazing presentation. I'm working in Germany as ENT specialist and there are so many patients with vertigo who have been treated for other diagnosis even though sometimes the migraine is so obvious. You are helping a lot with my work. Thanks and best regards from Germany

[mariopadilla]

Hi, nice presentation, have you tested the drops for the glaucoma in vestibular migraine, they have betablockers and work quickly by the eye mucosa. thanks