Do I even have MAV/MV or is it CSD+General Anxiety

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I’m starting to think my migraine doesn’t exisit.

After a podiatrist diagnosed my foot and toe numbness as a localized mortons nueroma due to high arches and narrow shoes, I’m beginning to doubt that I even have migraine, since the foot numbness was one of the key symptoms making me “think” it was migraine. Maybe my dizziness is actually psychogenic or some conditioned response to a series of “attacks” I had in early December, during a week of high stress and emotional turmoil at work, that basically has put my mind and body into permanent “fight or flight” mode. Looking back at the attacks, I initially thought they were occular migraine events, but the nature of my “aura” was a symmetrical strobing in my peripheral vision of both eyes and it did NOT have that one-sided blobby amoeba sensation that most people associate with aura.

Now I’m thinking these attacks were “panic attacks”. I’m starting to think its not migraine because I never had a one-sided headache or nausea or even rotational vertigo the entire past 6 months. Lately the dizziness is very situational and visually triggered, like it’s triggered a lot by restaurants, like there’s some hormone response to eating, weird lighting and over-stimulation of motion, and then once I acclimate after 20 minutes, it settles down. Or even leaving the dizziness-triggering setting, often by going into a scenario with calmer and more even lighting, causes dizziness to simmer down. Any sort of optic flow situation with lateral motion is a problem. Like walking through a subway concourse with people darting ACROSS my path. But my dizziness is also chronic and can be activated at any point by any situation if the problematic stimuli are present…but then it also resolves quickly.

The only weird thing is my chronic light sensitivity seems to overlap with Migraine symptoms, but I guess I’ve noticed my vision has been “enhanced” for a couple months now, like my contrast perception and after image perception is abnormally noticeable. This could also be related to being in a permanent “fight or flight” mode

I initially thought the weather was a trigger, but this might also be psychological, because there have been times when a quick rainstorm dropped in by surprise and it didn’t affect me because I was distracted by some engaging social activity or fun project.

My neurologist seems un-interested in the “neurological effects” of generalized anxiety. He also seemed to take my “Migraine” symptoms at face value and not question them too much beyond some generalizations. So what’s the best way clinically to parse out whether I’m having migraine or anxiety related imbalance? See a psychiatrist?

Depending on which scenario it is, I think the treatment would be different. For anxiety related dizziness, probably a combination of benzos, SSRIs, exercise and CBT would do the trick, For Migraine, restricted diet and a more “relaxed” lifestyle regimen plus TCAs or Topomax would be the treatment.

Anyway, how do you all suggest I determine whether its MAV or CSD?

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I would suggest getting the anxiety under control first which might eliminate some symptoms or all if the dizziness is anxiety related if its not anxiety related and it is migraine it is still a good idea to get the anxiety under control as anxiety can exacerbate migraine symptoms,WOW this is all one big vicious circle!

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MAV is just a collection of symptoms; who cares what you call it. I think the underlying issue with dizziness is always most likely to be ear related but that definitely can mean autonomic fight or flight involvement and a neurological element too. Anxiety will definitely make it all worse, get that under control. Amitriptyline helped reduce my anxiety by reducing the symptoms. Definitely worth seeing a qualified psychotherapist. Agree with Mel this area of the body is full of vicious cycles.

Restaurants: the wrong food can bring on dizziness and tinnitus. Try following a diet rich in diuretic vegetables and fruit, low in salt, carbs and eliminate caffeine (call it the migraine diet if you like but you are trying to attack the root cause which is water intake into the ear imho). You know you’ve got it right when your post meal symptoms are lesser imho. Lighting can challenge the vestibular system.

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but for me where is the actual migraine? when does it start and stop? I’m in this constant state that gets better or worse minute to minute depending on visual stimuli, but general stays at the same baseline, so it’s hard to conceptualize how the migraine could exist as a “state” rather than an “event”. Even in chronic migraines, I’m assuming there would be a progression of symptoms as the migraine takes hold, drops in and then releases over several hours, right (and then the next one might start immediately after!)?

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Imho you can have MAV without migraine but it’s clearly worse if you get migraines on top. In time I believe they will confirm it’s an inner ear upset.

In any case don’t focus on the name, look for solutions to calm your symptoms. Try everything and work out what works: meds, lifestyle (reduce stress) and diet.

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but I’m also pretty sure my inner is perfectly fine physically and neurologically–like I’ve never had problems keeping my balance or gotten sick in situations that would presumably be problematic for someone with a compromised inner ear. I can walk, run jump, read my phone while the subway is speeding around a curve and not lose my balance…so that’s why I’m getting dubious about the MAV diagnosis. I have already stripped my diet to the bare minimum as far as trigger avoidance, tried supplements, focused on getting good sleep and I’m not sure anything’s improving other than my attitude and mood. I also think if it’s something more along the lines of CSD rather than MAV I would try an SSRI next like Celexa or Effexor, rather than Topomax or Nort. Or try a heavy exercise regimen

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In some people, some SSRIs or SNRIs can also work (in mechanisms not fully understood by science yet) as migraine prophylaxis medicines. So they may end up helping you no matter what the cause. my case is a lot like yours, I don’t get “episodes” of migraine. Occasionally I will get a headache that progresses the same each time, so maybe every now and then there’s a “regular” migraine. Other than that the symptoms all flow together and there’s no start and stop. I, however, cannot read my phone on a subway or even ride on a subway, let alone run. Walking is difficult as I frequently lose my balance or feel like I’m being pulled straight down. It may end up that you’ll never know if it’s MAV or CSD, but they’re treated in similar fashions and relief is relief. Good luck!

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I don’t get ‘episodes’ either. Your brain is in a chronic migraine state. It is in an irritated state and not trusting the messages it’s getting. Sorry to disagree with turnitaround, but the ear isn’t necessarily a factor, it’s the brain that’s the issue and it needs time to calm down.

Anxiety and the migraine are in a vicious circle. It happens physiologically with this as the sympathetic nervous system is affected (that part of your brain is ‘irritated’), but also psychologically too. As you get on top of the migraine with meds, diet and lifestyle adjustments, the anxiety should ease too.

Try not to overanalyse things too much. Maybe the weather affects you sometimes but not others because other factors are in play too. Maybe you slept worse/ better the night before, maybe you needed to eat, maybe you were under different lighting. There are so many factors that affect this. It doesn’t always seem to make sense.t

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Well I may be unique but doubt it. My initial imbalance came on 15 minutes after minor trauma to my ear and I’ve had fluid in my ear every morning since until lately. 5 months later the imbalance came back. I’m positive the underlying pathology is a fistula as I can also exacerbate symptoms often by going on my haunches which increases the blood pressure in the head and clearly puts more pressure on the wound which then breaches again.

Migraine is definitely a factor but I believe it’s simply a reaction to the messed up lack of correlation between the ears that now disagree. I believe migraine is a state the brain gets into when the ‘learning gap’ gets too large but by artificially calming the brain you can help it compensate over time (unless you take too much medication acting as a vestibular suppressant)

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I would say most of the issue is your brain not trusting your balance centre…migraine etc is just the brain being irritable because its in the red zone…you may not show any migraine symptoms but i bet you have migraines…and the vertigo could be being triggered from any of the balance centres…usually your ears but not always. Think were getting a good grasp on what is goin on with just slight variations of a general theme. I do also think stress can trigger symptoms…I had a very bad tinnitus attack today with a reduction in hearing in one ear which lasted a while till i took a propranalol…i was at the time having a heated discussion about something at work…so triggering stress brain chemicals can also trigger episodes…