This is the third and final post in a series on a disorder commonly known as “Vestibular-Related Migraine.” I prefer the name, Gb-M&E syndrome (Genetic-based Migraine and Ear syndrome). The first two articles in this series contain the introductory material. Be sure to read those articles before this one. Not only does this conclude the series, but also of Dr. Martin’s contributions to HHTM. We are so honored he has been with us and passing along his knowledge, we wish 2016 to be a fantastic journey for Dr. Robert Martin!
A LITTLE BACKGROUND
Genetic research has found a defect in DNA code that helps us understand diseases that had previously been mysterious, hard to understand, and difficult to treat. These diseases include some types of dizziness, hearing loss, and nose problems. The great news is that once we have identified the genetic defect, it gives us a new and more successful path for managing the disorder.
Today I want to walk through a case study to illustrate ways that these new treatments can help patients.
Ann is a 37-year-old woman who has had problems with hearing and balance for many years. During her visits to our audiology practice, she has often reported that her left ear was “plugged” even though it looked normal and the tympanograms were normal. In this case, the plugged ear was probably caused by the toxic release into the ear causing inflammation in the ear. Ann tried using peripheral medical suppressants to reduce her vertigo, but these were unsuccessful. VNG studies showed a slight, but not significant weakness in the left ear.
When Ann returned to our office recently, we investigated her medical history and outlined her history of migraine. Ann’s long history of balance problems and migraine headaches makes it likely that the cause of her condition is genetic. She sees her family physician for help with her migraines. However, the medications he prescribed have not helped and so she has quit taking them. She is sensitive to motion, which makes it difficult for her to ride in the back seat of a car or in a boat.
A MULTI-STEP TREATMENT
Helping Ann with her problems involved several steps:
- We referred her to a neurologist who specializes in treating people with migraine.
- This doctor changed her medications, starting her on very low-dosage meds.
- The doctor has Ann working to reduce her “triggers.” It is believed that the same triggers are working for Ann’s migraine headaches and her “plugged ear.”
- Ann was given a list of online educational materials regarding migraine triggers. The government has many online sources that provide good information on migraine. CAN YOU SPECIFY A PARTICULAR AGENCY OR WEB SITE?
In the new theory of the vestibular migraine described in the previous parts of this series, successful treatment of the symptoms that cause migraine are also effective in treating related ear problems. Ann had luck with new treatment.
That will take readers directly to the referenced article.
*Technical note: In his lecture published in the March 21, 2013, issue of Audio-Digest, Otolaryngology, Michael Teixido, MD, discusses two forms of prophylaxis: eliminating triggers and prescribing medications that elevate threshold for onset of symptoms. He also lists first-choice medications (nortriptyline) and a variety of secondary medications (sodium and calcium channel blockers).
Most people are unaware that there may be an effective new treatment for a variety of problems that fall in the general category referred to as “Migraine.” It is not widely know that the pathophysiology of migraine syndrome may reach the ear and nose and cause a wide variety of problems there.
Among the treatments that have been found to be successful are very low doses–1/10th of the usual dosage–of traditional medications. All professionals working with hearing-impaired people need to be cognizant of this new perspective on an old problem.
Feature Image courtesy from EarthSky