The brain’s a wonderful thing and can cope with a lot.
I’ve written about this a lot on here, but I don’t believe Migraine is the cause of MAV. I believe that feed any normal healthy brain a lot of erroneous sensory signals that don’t correlate to what it expects for long enough and it might enter a migraine state. Migraine is just one of the outcomes of MAV. Dizziness is another, vertigo another.
The medical dogma going on here makes me mad!
MAV is defined by a set of symptoms, that’s it. In no way does it explain how a migraine could make you feel dizzy for very long periods of time or have a vertigo attack.
A real, spinning, vertigo attack must have a cause in the ear, imho. It’s obvious to me that you feel a sensation of spinning when fluid passes fairly quickly past one or more of your motion senses in your labyrinth - for that to happen there must be some kind of physical cause. A caloric test is one way to make it happen. Turning your head quickly is another, but you can only turn it so far!
If you read Dr. Hains web pages you will see that many ear conditions (BPPV, PLF, Menieres) can give you migraines, so I don’t think MAV is any more special.
My bet is that a lot of MAV cases are actually secondary hydrops - a problem with the pressure regulation in the ear - very similar to Menieres but with less or no impact on hearing. I hypothesise that in most ears, when pressure gets high enough, the fluid breaches one of the inner ear windows to the middle ear and flows out - this flow gives you the vertigo sensation. The breach (a fistula) then heals and at the same time the ear pumps out more fluid in order to equalise the pressure again. Unfortunately I bet that this ends up in hysteresis - it surpasses the healthy steady state and ends up over pressurised again leading to an inevitable vertigo attack. At all times when the pressure is too high or too low you feel dizzy (unless on meds that mask the symptoms) because the behaviour of your motion sense is compromised in that ear and not balanced with the other one. Over pressure might also have an impact on the neurons too.
I’m wondering if air gets in with each vertigo attack and this can also exacerbate the pressure regulation issue - maybe there are cells in the inner ear which check if they are sufficiently bathed in fluid and if not generate fluid themselves. This might go some way to explain the hysteresis.
It makes sense to me that in most ears high pressure would cause a leak in the window which is probably the best outcome rather than damaging an internal part of the ear - I’m betting they evolved this behaviour… That’s why I believe when MAV sufferers get a vertigo attack they don’t have increased tinnitus - because its not harming the hearing part of the ear. Menieres patients will give you a completely different story. The eustachian tube then makes double sense - a way of regulating air pressure AND a way of draining fluid! Breaches of the oval window are documented to cause tinnitus and hyperacusis - I have both and it fluctuates.
Secondary hydrops is known to come on between 6months to 10 years after an injury or pathogen insult to the ear. For me that explains why my MAV came on 5 months after minor trauma to my ear.
I have no proof of this but I believe my model explains all the symptoms I’ve experienced since this came on and imho doesn’t incorporate any fanciful idea of a migraine causing you to hallucinate any of these symptoms.
All this being said, there is definitely a huge cognitive impact of this issue and neurological medications can help loads in relieving symptoms. They don’t address the hydrops though and that’s why this thing ends up going on for months or years. I think it may eventually settle down but its probably best to take the meds so your quality of life is optimised in the meantime.
Stress probably exacerbates the pressure in the ear AND exacerbates cognitive reaction. Exercise of certain types might cause the vertigo attack to come on sooner (bending down is often said to be uncomfortable for MAV sufferers) - I know that I get most of mine in the morning when horizontal (I’m far from alone on this - do a search on ‘night spins’), and i’m sure there’s a physical reason for that - I doubt you are under most migraine stress in the morning after having had a good sleep!
However, I think moderate exercise is a must to help you cope and will help the brain learn to deal with the more noisy signals than it is used to getting, so please continue your hiking and walking - thats got to be good for you anyway!
I’ll get off my soapbox now!