A Few Words...

What is written here is my opinion and personal experience only. I am not qualified to give advice - medical, legal, or otherwise. Please be responsible and do your own research regarding treatments, diets, doctors, and alternative therapies.

Thursday, February 5, 2015

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.

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.


  1. I've read this by Dr. Hain before, and I guess I'm lucky...my doctor has given me Valium and Phenergan from the beginning and told me to use it when I felt an attack coming on. Do not hesitate. and I don't. I have heard so many people that are so afraid to take their meds, and I do not understand it. they would rather suffer though an attack. Not me, if I can make it better at all, I will do it.

    Meclizine...that's like taking a candy pill for most of us. Those who get relief from that with this disease, well...and it isn't just me saying this, I've heard it from several doctors now...it's mainly a placebo effect. It may help a little with the minor dizzies, but for vertigo, not so much. It simply doesn't calm down the vestibular system.

    I cannot lie down on a firm surface. that would be the floor. and I cannot stand to be on the floor when I have vertigo. If I'm going to throw up I don't want to have to lift my head, just hang it over the side of the bed or couch is better for me. But maybe it's because I have a temperpedic mattress so it doesn't really move and shake.

    I had my doctor tell me to focus on a still object, but not how close. I always tried to look at the corner of a room when I first started having this, it didn't work. I found an object about 1-2 feet away is good. And after reading a lot, I found reading vestibular stuff from John Hopkins that looking far to the left or right...like turning your eyes in your head really far like that can make your vertigo slow...and it does. but I can't stay like that for long, makes my eyes hurt.

    Biggest thing for me it to not panic. Just relax into it. Breathe. I used to start having short panic breaths and just couldn't calm completely down. Now I really try to stay focused and calm. It helps a lot.
    That is something I really wish someone had told me. How anxiety plays a huge roll in this. How the more anxious you are during an attack the worse it will be, and possibly the longer it will last.

    I'm having a spell again. It isn't as bad as the last time. I've only had 1 bad spell and a mini attack, but today I feel like it's coming. I had a little spin...I guess it could be called another mini...but it has calmed a bit. Having a bit of trouble not worrying about the future....what if I start having the bad spell again, and I can't take steroids? "What if" isn't good for anyone. Living in the future, is not good for me. But it is a very hard thing to stop. I know it will only make this worse....something I wish my doctor would have told me.

    I wish my doctor had sent me to a Mindfulness Based Stress Reduction class. I think it helps so much.

    I do think we learn so much more from others than we do from our doctors. My doctor once said he doesn't tell us more because people are so different. what may work for some doesn't work for everyone. However, I've found that what works for some of us, works for many of us. Yeah, it may not work for all, but it works for enough it's worth sharing. They should give us a pamphlet at least.

    Good post, thanks for sharing.

    1. Wendy, You are so right about the meds. Take them if you need them! The first year I had Meniere's I mentioned to my OTO that I was taking meclizine which "maybe helped" and he didn't say anything one way or another about it. Didn't offer a benzo or antiemetic. Then, long-story-short, I ended up in an ENT's office mid-attack, holding my bucket in hand. He made sure I left his office with a prescription for Valium and scopalamine. For the first time I was actually able to rest during my 12-hour marathon vertigo attacks.

      My OTO didn't give Valium to me because, at least according to one of his fellows, "it will slow down how quickly your brain will adapt to vestibular loss." WTF? That was the least of my problems, but I didn't know better at the time.

      I read a study recently which looked at people with anxiety. They did vestibular testing on this group and found something like 25% of them had undiagnosed vestibular dysfunction. The study concluded that there may be a vestibular component to anxiety which is kind of the opposite of having anxiety b/c of vestibular dysfunction. Interesting, eh?

      I love your idea of at least a handout about how to cope and learn techniques to calm one's self during an attack - and in general. I agree with you, I could never lay on the floor during an attack. And sometimes I simply could not keep my eyes open or closed - it was miserable either way. "Milder" attacks might allow me to focus on a stationary spot, but I never tried looking to one side or the other. Fortunately, I haven't had vertigo in over a year, so hopefully I'll stay on the trajectory for as long as possible.

      My doctor also didn't particularly like patient forums or support groups and I can understand why b/c one really has be able to filter through a lot of misinformation. But, on the other hand, as you pointed out, we have to learn from each other b/c (a) our doctors cannot possibly understand what we are going through and (b) they have about 10 minutes with us - no time to filter through the details of what we've read, heard, or thought about since our last appointment. Generally, I leave these doctor's appointments feeling frustrated and like I've wasted my time - unless I was getting a dex or gent shot, then I was very relieved and thankful for the hope.

      I love, love, love mindfulness meditation! Definitely worth the time to learn and practice.