Suggest Treatment For Vertigo And Ringing In The Ears

Brief Answer:
Neurology consult for headache disorder

Detailed Answer:
Good morning. I am a neurologist and headache specialist from XXXXXXX OH and would like to make a comment on your question. Your wife's symptoms of vertigo and tinnitus have been diagnosed as Meniere's disease which apparently runs in her family. You state that she drinks large amounts of water without apparent cause and complains of glare from lights at night.

This one particular entity as a neurologist who deals with headaches that I will tell you could be at play here referred to as vertiginous migraine or equivalently migrainous vertigo which is a type of migraine headache associated with severe sensations of vertigo, possible tinnitus (ringing in the ears), photophobia (sensitivity to light which could explain her problems with glare at night), and of course severe headache which could also be accompanied by nausea and vomiting.

Many people with Meniere's already have some of these same symptoms such as severe nausea and vomiting and tinnitus and therefore, we find that there is a chance of error in diagnosis between these 2 entities. One thing which is TYPICAL for Meniere's which is not seen in the headache disorder I mentioned is HEARING LOSS. There is very commonly (if not almost required) significant hearing loss in the affected ear of someone with Meniere's disease. Therefore, if your wife does not suffer from a significant hearing loss in the ear which is the one diagnosed with Meniere's I would revisit that diagnosis and ask whoever made the call to walk your through why they feel that's the case.

Also, if there are NO SEVERE HEADACHES in her at all then, she almost certainly DOESN'T have vertiginous migraine since that type of headache disorder always has a severe headache associated with the typical symptoms of nausea, vomiting, light sensitivity, and possibly tinnitus.

If she does complain of bad headaches one way to tie the Meniere's diagnosis together with the headache is to ask if she always or at least almost always has her headaches along with a Meniere's attack or are they separated from each other by hours or even days? In other words, if she has headaches does she tend to have headaches AT THE TIME of a vertiginous attack or is it more the case that she can have a very bad headache one day without vertigo, without ringing in the ear, etc. and then, at some time later have a bad attack of vertigo?

Also, in vertiginous migraine cases the duration of the vertigo itself along with nausea and vomiting episodes is usually on the order of several minutes to about an hour at which point the Headache becomes fulminant and can continue to disable the person. In Meniere's attacks (with the nausea/vomiting feature/tinnitus) can go on for hours at a time no matter whether the person rests or not and no matter their position.

As far as the large amounts of fluid are concerned there is a condition I don't know what relationship, if any, there may be between the diagnosis of Meniere's and this condition. You didn't mention whether or not she has large volumes of clear urine throughout the day that goes along with that. If so, then, she may be suffering from something known as DIABETES INSIPIDUS. This can be looked at by her doctors and tested by other means.

Light glare only at night could also be a symptom of night vision problems or cataracts which can be diagnosed by an ophthalmologist.

I'd appreciate the favor of your providing a STAR RATING and some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will also be most helpful to expedite the transaction associated with this question and to also allow the information in this case to be archived so that other doctors may use the data to their advantage to anyone with a similar problem.

Don't forget that my webpage to keep me abreast as to how your wife's doing is:

bit.ly/drdariushsaghafi

All the Best

This query has required a total of 46 minutes of physician specific time to read, research, and compile the return to the patient.

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Brief Answer:
Not migraine variant then

Detailed Answer:
Thank you for the additional information which helps narrow things down for us.

Therefore, according to what I have said previously and according to the information you have just supplied if she has NO HEADACHES at all but just these intense forms of vertigo and tinnitus she cannot have the migraine variant I mentioned known as vertiginous migraine. You did not say whether or not she has hearing loss in the affected ear where she seems to have her tinnitus. But it seems more likely to me at least that we are talking about a case of Meniere's disease as opposed to migraines or anything.

A neuro-otologist would be the most highly specialized neurologist that may be able to help with your wife if she has not yet seen ENT which is usually the way most referred Meniere's patients end up being referred. Depending upon the strength of the family doctor they may certainly be able to manage and take care of Meniere's patients adequately since there is really no definitive cure for Meniere's disease, however, to my way of thinking as a neurologist it wouldn't hurt if she were to seek an opinion of a specialist such as neurology, neuro-0tology, or ENT.

As far as the diabetes insipidus is concerned there are blood tests that can be specifically looking for chemical substances that can lead to its diagnosis. Because of the fact that she has the Meniere's I would also get an MRI of the brain since the root cause of diabetes insipidus can be a particular brain in the area of what we call the hypothalamus. So if there were something there that was also causing some type of problem that occur in the ear as well....you may knock out 2 birds with one stone.

Of course, against the notion of some type of brain mass or lesion of significance is the fact that you just said above that she has NO HEADACHES and this pretty much takes out mass lesions in the brain as that is frequently accompanied by worsening headaches as time goes on...or at least severe headaches for SOME period of time. Nevertheless, as a specialist you can't blame me for wanting to play with type of technological gadgetry! HAHA!

Diabetes insipidus has nothing really to do with diabetes mellitus except for the fact that in the 2 conditions both patients will have excessive thirst. But in DI it can be EXAGGERATED....you also did not mention is her urine output was LARGE VOLUME and clear which is typical for DI patients....lots of thirst and lots of clear pee. Up to 21 quarts a day! Yowza!

Again, I hope these answers have helped you along a bit more and I'd appreciate your providing a STAR RATING withsome brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will also be most helpful to expediting this transaction as well as allowing the information in this case to be archived so that other doctors may use it to their advantage for anyone with a similar problem.

Don't forget that my webpage to keep me abreast as to how your wife's doing is:

bit.ly/drdariushsaghafi

All the Best

This query has required a total of 63 minutes of physician specific time to read, research, and compile the return to the patient.

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Brief Answer:
Possible migraine attack

Detailed Answer:
Thank you for doing your due diligence....as I said before migrainous vertigo is often misdiagnosed as Meniere's disease simply because episodes of vertigo and headaches are so far removed from one another that nobody (including doctors) think about them as a possibility or that one thing could be related to another.

The next step in the process (if I were treating your wife) would be to get her to fill out a diary of headaches. That way, she can document the exact symptoms she gets of both the vertiginous symptoms, the tinnitus, the headaches, and the associated aura (phosphenes; lightning bolts) to really see what the patterns and relationships may be. A diary like that usually takes about 4 weeks to obtain the necessary data in order to really ferret out what's what. Then, I would implement a plan or strategy for treatment. Often times treatment for the vertigo tends to follow the treatment plan of the headaches, or it could be separate.....but the other part of the equation is that as the headaches are successfully treated the vertiginous episodes began to disappear little by little.

Again, I'm glad you were able to discover a little more information and perhaps this will lead to more successful treatment strategies for her. The fact that there is a family history as well of migraines gives more credibility to that as a diagnosis. I'd be curious to see what the nocturnal glare is all about. Perhaps, that is headache related as in "Photosensitivity" OR....she could have cataracts....

Again, I hope these answers have helped you along and I'd appreciate your providing a STAR RATING with some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will be most helpful in expediting this transaction and allowing the information in this case to be archived so that other doctors may use it to their advantage for anyone with a similar problem.

Don't forget that my webpage to keep me abreast as to how your wife's doing is:

bit.ly/drdariushsaghafi

and remember that as a headache specialist this kind of thing along with my recommended headache diary/log is the core of what I'm all about so feel free to call on me if you can't find headache specialists...or at least neurologists in your area.

All the Best

This query has required a total of 113 minutes of physician specific time to read, research, and compile the return to the patient.

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