ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

A Personal Spin on Migraine-Associated Vertigo Treatments: With few formal guidelines, otolaryngologists use trial and error

by Bryn Nelson • June 1, 2011

  • Tweet
  • Email
Print-Friendly Version

For a first or second-line therapy, common drugs of choice include verapamil (Calan) and the tricyclic antidepressant nortriptyline (Pamelor). For verapamil, “We use it in a very low dosage, below levels that we would use for blood pressure control,” said Aaron Benson, MD, clinical adjunct professor of otolaryngology head and neck surgery at the University of Michigan and Michigan State University. “I find that to be very effective in my patients and it has the lowest side effect profile of the medications that I can normally offer to patients,” said Dr. Benson, also medical director of the Ohio Hearing and Balance Institute at St. Luke’s Hospital in Maumee.

You Might Also Like

  • What Are the Diagnostic Criteria for Migraine-Associated Vertigo?
  • Vertigo in the Elderly: What Does It Mean?
  • Migraine-Associated Dizziness Is Elusive to Diagnose
  • FDA Advisory on Triptans and SSRI/SNRIs Will Not Affect Migraine Treatment, Say Experts
Explore This Issue
June 2011

Dr. Foster agreed, noting that verapamil is a good choice for patients with hypertension or arrhythmias. How the drug works is less clear, especially in light of the uncertain etiology of migraines. One hypothesis suggests symptoms may be related to a vasospasm of the blood supply to the posterior fossa. Another posited that the condition results from a disruption of calcium ion channels. Either way, Dr. Benson said calcium channel blockers make sense as a first-line therapy. “A calcium channel blocker relaxes vessels so it would work if it’s vasospasm, and if it’s a calcium ion channel problem, well, it’s a calcium channel blocker,” he said. “I find that to be an extremely effective medication.”

Dr. Goebel often starts with the relatively inexpensive nortriptyline, which he prefers over its chemical cousin amitriptyline (Elavil) because it is less sedating and patients aren’t as likely to gain weight. Dr. Foster noted that amitriptyline’s sedative effect can be a plus for patients with poor sleep patterns, thereby also removing lack of sleep as a potential migraine trigger. Other side effects can include dry eyes and a dry mouth, and both drugs are usually contraindicated for pregnant women.

The potential mechanism for action by tricyclic antidepressants in addressing migraine is poorly understood, though some researchers suggest that regulation of the serotonin neurotransmitter may play a role. Experts also note that antidepressants have been widely used for pain control.

New Options

Among the few promising new drugs, Dr. Foster pointed to Namenda (memantine), normally used to treat Alzheimer’s disease. The drug seems to work best in cases with prominent aura, she said, when the inner ear may be damaged by low blood flow, by blocking the NMDA [N-methyl-D-aspartate] receptor calcium channel. That channel is involved in excitotoxicity, or the death of nerve cells from excessive stimulation, a pathway that Dr. Foster has been exploring as the mechanism for severe attacks. “If you can block excitotoxicity, you can block the damage,” she said. “So for people with progressive damaging disorders who have migraine, blocking that kind of damage then prevents the disorder from progressing.”

Pages: 1 2 3 4 5 | Single Page

Filed Under: Everyday Ethics, Head and Neck, Medical Education, Otology/Neurotology, Special Reports Tagged With: migraine, neurotology, otolaryngologist, treatment, vertigoIssue: June 2011

You Might Also Like:

  • What Are the Diagnostic Criteria for Migraine-Associated Vertigo?
  • Vertigo in the Elderly: What Does It Mean?
  • Migraine-Associated Dizziness Is Elusive to Diagnose
  • FDA Advisory on Triptans and SSRI/SNRIs Will Not Affect Migraine Treatment, Say Experts

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Vertigo in the Elderly: What Does It Mean?
    • Experts Delve into Treatment Options for Laryngopharyngeal Reflux
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Weaning Patients Off of PPIs
    • New Developments in the Management of Eustachian Tube Dysfunction
    • Vertigo in the Elderly: What Does It Mean?
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Eustachian Tuboplasty: A Potential New Option for Chronic Tube Dysfunction and Patulous Disease
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Podcasts Becoming More Popular Method of Education for Otolaryngologists
    • How to Embrace Optimism in the Midst of the COVID-19 Pandemic
    • Tips on How to Approach Conversations with Patients about the COVID-19 Vaccine
    • Steps You Should Take to Protect Your Voice and Hearing During Telemedicine Sessions
    • Routine Postoperative Adjunct Treatments Unnecessary for Idiopathic Cerebrospinal Fluid Leaks

Polls

Have you spoken with your patients about receiving the COVID-19 vaccine?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2021 The Triological Society. All Rights Reserved.
ISSN 1559-4939

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.