Managing a Vertigo Attack - Stuff I Wish I Had Been Told by My Doctors

Despite seeing a couple of very highly-respected neurotologists and at least two caring ENTs since being diagnosed with Meniere's disease almost six years ago, much of what I know today about the the disease and how to cope with it has come from online forums and Meniere's and hearing loss websites.  Among the contradicting advice I've received over the years involves the use of hearing aids (don't get me started), vestibular suppressants (doctors say don't use them, but the following article - and most sufferers - will beg to differ), and information on the underlying causes (the doctors tend to quickly say 'we don't know', implying they have no idea, but the literature offers at least a few good working theories which the doctors will only talk about if pressed).  Anyway, I digress.

Today I received the following article in my email inbox and found it to contain information I wish I had been given the day I was diagnosed with this miserable disease,  I hope someone finds it at least a little bit helpful during their next attack.

Managing a Meniere’s Attack

By Editor On February 4, 2015

Editor’s Note: Today’s post appeared last month at the Dizziness Depot. We thought it was worth sharing this week at Hearing Views in case you missed it. In today’s post, Dr. Desmond discusses how to manage the debilitating dizzy spells, or “attacks”, caused by Meniere’s disease.[1]
By Alan Desmond, AuD

If you have the flu or a bad cold, the natural response would be to drink fluids and to go to bed until you are feeling better. If you have a bad migraine, lying down in a dark room often provides some relief. Of course, due to the contrarian nature of Meniere’s disease, these activities will most likely make you feel worse. First, I will reprint a short passage from Dr. Tim Hain’s website (I highlighted some text), followed by an explanation of why his advice makes sense.

“How do I manage an attack?”

During an acute attack, lie down on a firm surface. Stay as motionless as possible, with your eyes open and fixed on a stationary object. Do not try to drink or sip water immediately, as you’d be very likely to vomit. Stay like this until the severe vertigo (spinning) passes, then get up SLOWLY. After the attack subsides, you’ll probably feel very tired and need to sleep for several hours.

If vomiting persists and you are unable to take fluids for longer than 24 hours (12 hours for children), contact your doctor. He can prescribe nausea medication, and/or vestibular suppressant medication. He/she may wish to see you or even admit you to the hospital if you are dehydrated. Meclizine (Antivert), Lorazepam and Clonazepam are commonly used vestibular suppressant medications and Compazine, Phenergan or Ondansetron are commonly used medications for nausea. In our practice in Chicago, we commonly prescribe an “emergency kit,” consisting of a small prescription of lorazepam and ondansetron, to be taken sublingually for an acute attack.”

Why a firm surface rather than going to bed?

During a Meniere’s attack, the inner ear is telling you that you are moving. When you are in bed, you have reduced tactile cues about movement and position. Think about how much more difficult it is to maintain your balance of a soft surface like a pillow or foam cushion. The brain is searching for reliable information and tactile feedback, which is much more reliable when received from a solid, ungiving surface. I recommend patients lie down on the floor, up against the wall in a corner and give themselves as much tactile feedback as possible.

Why keep your eyes open and fixed on a stationary target?

The nystagmus (rapid involuntary jerking eye movements) generated from the asymmetric output of your two labyrinths during an attack is what is making you feel as if you are (or your world is) spinning around. By staring at a fixed object, you can slow down the speed of the nystagmus, more so if you look out of the corner of your eye, opposite the direction that the nystagmus are beating. You have to experiment with this: Look out of the right corner of your eye for several seconds, then the left. Make a judgment about whether one side seems better or worse than the other.

This advice incorporates two basic rules of vestibular science:

1. Nystagmus of labyrinthine origin is suppressed by visual fixation –meaning the eye movements (nystagmus) and associated vertigo slow down when the eyes are open and staring at a target.

2. Nystagmus of labyrinthine origin increases in speed when gaze is directed toward the fast phase, and decreases when gaze is directed toward the slow phase –meaning that the eye movements and associated vertigo slow down when the eye is directed away from the direction that the nystagmus is beating. That direction isn’t always predictable and may change during an attack, so you have to experiment with this.

Why take a vestibular suppressant?

Vestibular suppressants may help reduce nausea during an attack.

The nausea is nature’s way of telling you that something is wrong with your vestibular system and that you should probably stay home. You are unsafe to be out hunting or gathering or whatever. Vestibular suppressant medication dampens the information received by the brain from the labyrinths. During a Meniere’s attack, that information is asymmetric, incorrect and making you miserable, so a vestibular suppressant reduces that asymmetry, and reduces the nausea. Of course, the effects will linger after the attack is over and you need to be cautious about sedating effects of the medication if you try to drive. Most people just want to sleep for several hours.

Why take the medication sublingually?

Once an attack starts, medications must be taken sublingually or through a suppository because the vomiting response won’t allow anything to stay down very long.

The bottom line – During an acute Meniere’s attack the inner ear is telling you that you are moving, while the brain, the eyes, and the sense of touch tell you that you are not. This sensory conflict produces nausea and disorientation. Shutting down the labyrinthine response and increasing the visual and tactile feedback will most effectively combat the error signal coming from the affected ear.

Footnotes
Ménière’s disease is a disorder of the inner ear that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or congestion in the ear. Ménière’s disease usually affects only one ear.