The Vestibular Migraine Community

Amitriptyline 100mg?


#21

Hi James,

I agree with you. But there is a gap which i am not able to explain. Which is how does SSRI fix the problems for some folks that they start feeling 90% to sometime even normal. If the source of imbalance is vestibular then the imbalance should always exist. The SSRI probably increase the threshold of the brain and prevent it from freaking out which cause migraines and further dizziness. Even on SSRI the person should be able to sense the imbalance especially if it is variable and the brain treats this as noise.

In my case Amitriptyline has avoided the migraines at 20mg. But there is a constant sense of imbalance 24/7 sometimes worse and sometimes barely noticeable. So in my case i am with you that the source of my troubles lies in my inner ear. But at the sametime could there could be people out there whose problem is in the Central(CNS) and fixed by SSRIs nd hence able to get to almost 100%. This could also explain the ladies experiencing more trouble during the day of the month.


#22

Very interesting @GetBetter. That was kind of my point too, that maybe most of what I am dealing with is central vertigo. But I’m also wondering what hormones have to do with all of this too. I’m hoping that I can find a better treatment option for myself as I feel kinda the way I used too right now.


#23

Sorry for slow reply, I’ve been running around like crazy trying to clear my flat and putting all my stuff into storage (yes symptoms are generally good enough to do that now, hurrah!)

Identical to my experience. But we need to distinguish ‘migraines’ from ‘vestibular attacks’ because what I discovered to my disappointment 6 months after starting Amitriptyline was that it didn’t help avoid the latter.

I just don’t believe (and I accept this is a personal opinion), that the vertigo sensation (violent spinning) is caused by anything other than a dysfunction of the inner ear - because THAT is the organ that senses motion!

Also I understand the inner ear windows between the inner ear and middle ear are supposed to be the thinnest membranes in the body. Perhaps this is so they prevent damage to hearing - ie if the inner ear pressure goes up too high (easy, its surrounded with bone), this membrane breaks first and lowers the pressure - thus saving your hearing!! Evolution is a wonderful thing. So next time you get spinning think yourself lucky - it could be preventing hearing loss!

Unfortunately this also means they are REALLY susceptible to injury. Which to me suggest injuring them is going to be more common than many people realise.

Fluctuating tinnitus too - that is surely an issue with pressure in the inner ear. Hearing loss definitely is, unless its down to wax, an issue with the stapes, ear drum, swollen ear canal or a blocked Eustachian tube, but they are in any case ear related.

So if you have episodic vertigo, tinnitus and a feeling of ear pressure that is surely to do with the ears?! If you have all that and any impact to hearing at all, that’s definitely ear trouble.

If its just dizziness and NOTHING ELSE there might be a chemical cause? E.g. when you drink alcohol. But I’ve never had tinnitus from drinking alcohol. And the violent spinning I’ve had with ear trouble has been VERY different to the spinning I’ve felt when woozy.

I really don’t think we should, however, be blaming the brain for all these sins, its nowhere near as delicate as the ear, so far less likely to suffer injury or infection.

And if its was the brain, how come its only affecting vestibular aspects? Why wouldn’t you be getting a feeling of pressure in your feet or cold hands? Sorry, just not convinced. This is surely ear trouble!

There IS however, MOST DEFINITELY central INVOLVEMENT. Because I’ve had episodes of ear pressure/pain and unusual tinnitus in my GOOD ear, as well as migraines, brain rumbles, brain fog, etc. etc. I suspect there is a pressure regulation process that covers both ears simultaneously and if you hurt one ear, it can cause issues with the pressure regulation of both.


#24

Thanks James. Not being able to definitely know what is wrong in the ear is fustrating.I have never felt normal after my initial vestibular event (Not calling it VN as no one can tell with certainity). The migraines were a comorbidity which made the ride bumpier and now have eased the migraine part. But the truth remains to be seen if something else is going on. I am getting a VEMP test done to rule out superior canal dehiscence and possibly secondary hydrops.

Do you know for endolympatic hydrops the effect is constant or episodic ?. Since my symptoms are constant in the case have a floating sensation while i walk i think it is some damage done during the intial vestibular event and the fine tuning (compensation) is not 100% there yet slowed even more by the migraines.


#25

Both constant (a baseline) and fluctuating. My baseline has improved but it’s still not great. But apparently the brain can adapt. And in some lucky people it can go altogether … so they say … especially once the ‘underlying cause has resolved’


#26

The underlying cause no one really knows. I pray that things heal on their own and save us a lifetime of trauma. This thing is really the worst form of illness and needs every ounce of our strength to match forward


#27

Oh I think the cause of hydrops in the case of a fistula is pretty obvious:. If the perilymph pressure drops due to a leak the endolymph area will expand. When the leak is stopped you end up with perilymph trying to take up its original volume which is now taken up in part with endolymph, they clash and symptoms evolve into a new phase of Secondary Hydrops. If this pressure builds up beyond a threshold you get a leak from the weakened membrane where the fistula was. Then you get the episodes and the constant stuff. This fight apparently resolves eventually for most: perhaps it takes a while for the pressure to return the endolymph to its original size (by which time the pressure drops). I wonder however just how the pressure regulation works? Is it by volume somehow or pressure on some sensors?

I also wonder if this is the primary mechanism for loss of hearing with age. My bad ear shows the same loss you get with age. Caused by the changing physical audio response of the whole ear due to pressure and not necessarily anything do to with hair cell death although that may be another factor in later life. Suggesting that maybe this aspect is reversible of you can bring the pressure back under control.

I wonder if there is another part of the body with a similar ‘balloon in a balloon’ set up like this. Should imagine there is a similar mechanism there


#28

Nice description. What you described is that called Secondary hydrops. I like the balloon pressuring each other analogy. Does this mean Fistula and hydrops go hand in hand. Can hydrops exist without a fistula ? I have heard of Cochlear hydrops and endolymphatic hydrops not sure what the difference is.

I beleive Meniere’s is when the membrane between perilymph and endolymph gives away and both fluids mix and cause the attack and the membrane rejoins and the attack stops. Hence Meniere’s goes by the name primary hydrops ?


#29

Possibly. Though I’ve read many accounts of this being an outdated concept. It may be the same mechanism as for fistula. Difference is in Menieres there’s also structural destruction and this shows up as loss of low frequency hearing. This is not reversible. I wonder if Menieres is caused by both an increase in pressure plus a scarred or over stiff window into middle ear which allows pressure to increase to destructive levels in the ear instead of the window breaking to release the pressure. Or same pressure just overly weak membranes in cochlear. Btw menieres patients lose low frequencies mainly because the low frequency end of the cochlear has a structure that’s suppoosed to be 100 x weaker than the high frequency end.

Don’t forget there is essentially liquid on each side of a membrane pushing against each other. Whilst the membrane might be squeezed I can’t see why this would lead to it breaking. I don’t think it is being stretched though this would need to be visualised in 3D as it’s not a simple surface. Perhaps there is some deformation due to the variable pressure on each side which breaks some structure eventually. And if it broke I can’t see why this would lead to the pressure dropping as liquid on both sides is at pressure so there is no additional room created. No I think the middle ear windows have to be involved for pressure to drop: that’s the only escape. I think medical scientists need to consider physics more.

And perhaps ‘balloon in a balloon’ should be ‘balloon in an egg’ because the outside fluid container is stiff. It’s bone.