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Spontaneous vertigo and headache: Endolymphatic hydrops or migraine? - Original Article

Ear, Nose & Throat Journal, Dec, 2001 by Thomas E. Boismier, Michael J. Disher

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We initially treated these 46 patients for endolymphatic hydrops with a strict diet that featured a low intake of sodium (1.5 to 2 g/day) and a high intake of fresh water (24 to 32 oz/day). A few patients also received diuretic drug therapy at the discretion of the referring physician. Our treatment goal was to stabilize body-fluid levels and thereby prevent fluctuations in levels of endolymphatic contents. Endolymphatic balance is presumed to help control spontaneous vertigo attacks. (6,7)

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Patients whose symptoms were not controlled by treatment for endolymphatic hydrops after several months were referred to the neurology department for a migraine evaluation and possible treatment with a prophylactic migraine medication such as verapamil, propranolol, or amitriptyline. (8) Vestibular rehabilitation therapy was prescribed as an adjunctive treatment for those patients who experienced significant unsteadiness and/or motion-provoked symptoms between vertigo attacks, provided that their attacks occurred no more frequently than every 6 weeks. (9) Measurements of symptom severity and disability scores were taken several times during the course of treatment.

After treatment had been in place for a minimum of 4 months, we attempted to reach each patient by telephone to obtain DHI, symptom severity, and disability data (mean length of treatment before contact: 11 mo). Six months after each telephone contact, a second telephone survey was conducted to obtain data on symptom severity and disability. We then made comparisons of pre- and post-treatment status.

Results

First follow-up. We were successful in contacting 23 of the 46 patients during our initial telephone survey. According to their scores on the various assessment tools, 14 of the 23 patients (60.9%) experienced improvement in their condition following treatment for endolymphatic hydrops alone (EH group) (figure 1). Six patients (26.1%) had not improved with treatment for endolymphatic hydrops but did subsequently experience an alleviation of symptoms after they had been referred to a neurologist and prescribed treatment for migraine-associated vertigo (MAV group). The remaining three patients (13.0%) said they had not complied with their endolymphatic hydrops diet or followed up with their referring physician (noncompliant group). None of these three patients experienced any improvement; in fact, their dizziness worsened dramatically.

Dizziness. According to a comparison of mean DHI scores before treatment and at the first follow-up, those in both the EH and MAV groups experienced an alleviation of dizziness--reductions of 42 and 23%, respectively (table 1). Those in the noncompliant group experienced a 90% increase in mean DHI score.

Symptom severity. Similar findings were observed in all three groups in terms of symptom severity (table 1). The EH and MAV groups experienced mean decreases of 54 and 44%, respectively, in symptom severity scores, while the noncompliant group had a decrease of only 5%.

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Spontaneous vertigo and headache: Endolymphatic hydrops or migraine? - Original Article

Ear, Nose & Throat Journal, Dec, 2001 by Thomas E. Boismier, Michael J. Disher

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