Question: My daughter, 19, has been suffering from vestibular migraine on and off for over 3 years. She is intensely dizzy for weeks at a time. She is very thin and weighs only 45 kg. She has tried a number of medications. Initially. she was put on 250 mg Dicorate ( sodium valproate), 40 mg Inderal ( proplanol) and 10 mg Betavert . She was also told to folow the anti migraine diet. This worked for about a year. But then she had a relapse and her then regime seemed not to work. She then tried Sibellium which did not work either. Since last July she has been prescribed 20 mg of Amitryptaline a day along with 250 mg Dicorate. This seemed to work for about 4 months but now she has had another relapse. Tried upping the dose to 30 mg but it just made her very sleepy and tired. Should we try another medication like topamirate, verapamil, noritryptalline or pitizufen? She is prone to anxiety so I am wary of Topamirate. Or should we persist with amitryptaline? On amitryptaline she gets about one bad attack every 3 months which last for a couple of weeks.

Dear Dr Bhavsar,

Thank you for replying immediately.

(1) Yes, serum electrolytes were done
(2) MRI Brain done
(3) Hearing tests and videonystagmus tests done.
Nothing abnormal found. Have consulted several neurologists who all agree it is vestibular migraine. I am pretty sure that it is vestibular migraine because if she eats a trigger food, like Chinese or too much chocolate/caffeine, she gets dizzy. She has now given up all the trigger foods.

So, if I understood you right

(1) you suggest she take Flunarizine, Propranolol, Amitryptaline and Valproate all together? She has already tried all these medications, asi I said, in different combinations. She tried Flunirizine ( Sibellium) and Propranolol last year, and they stopped working. Now she is trying the other two together. As she is so thin the medicines make her very drowsy and tired. I am quite wary of trying all of them together.

(2) If you suggest the above, what is your suggested dosage please? Given her weight is only 45 kg. The amitryptaline makes her lose weight rather than gain weight, strangely.

As I said earlier, she has tried flunirazine already with no improvement in her condition at all. I see no point in trying it again.