Concluded Case

?Migraine ?Cluster Headache

Patient complaints of vertigo & headache since 1 months on off. BP - WNL FBS- WNL CBC,LFT,RFT- WNL. MRI BRAIN- NORMAL STUDY. X Ray C-Spine - Normal No H/O middle ear infections. No H/O any trauma. Audiometry & Typanometry - Normal study Patient is taking Betahistine 16 mg Od.Also took Cinnarizine tab in the past. What could be th possible cause of vertigo? What is the management now? Can the treatment be Betahistine,Cinnarizine be continued or some other medicines to be added?

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Concluded answer

Propranolol�+�Flunarizine Is good combination for this patient. Migraine as like symptoms. spinal related causes rule out.

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Age of the patient? Any H/o whiplash or head/neck trauma? Duration of vertigo and headache once the episode starts? Any relation to specific activity? Does vertigo precedes headache? Any h/o migraine headaches in the past? Drug Hx? Rule out any anxiety/worry/depression/sleeplessness that patient has not been attributing his/her symptoms to. Long term betahistine and cinnarizine cause disequilibrium problem as the internal ear becomes more dependent on them. Better to avoid. Adv: Physiotherapy/ENT referral.

How old is the patient? Needs more history. Vertigo is associated with head ache or not.Both in young or muddle aged pt ,one has to think the possibility of basilar artery migraine. Duration of both is important. Brief duration seconds to mts one has to exclude a seizure disorder.. Vertigo and head independent, the possibility of benign paroxysmal Vertigo with or with out migeaine.All these needs good history.

Why no treatment is given here for headache? You can add Analgesic to Betahistine+Cinnarizine. R/o Posterior circulation stroke. Look for Ataxia/Neurological signs. ECG, RBS has to be done. R/o orthostatic hypotension.

first of all this is not vertigo.. any sensation of dizziness is not vertigo. clinical history is very important..patient may be having anxiety and stress

? MIGRAINE.. ? MEINERS DISEASE.. ? BPPV .. NEED'S..CLINICOPATHOLOGICAL EVALUATION WITH EXPERTS OPINION

vertigo  have given ShiroDhara treatment for 7 days and Swarnasutshekhar Ras+Saptamrat loh +brami vati +Vomitab syp + medice for low B.p for 1 month now her sleep is normal and she is feeling much better.Dr sangeeta ji for imbalance of eletrolyte what should be done.ply suggest.

Assess for presence of spondylosis. Teach him neck exercises

Age? Cervical x ray ? ENT opinion Eye sight problem? Postural relationship of giddiness Tab Ecosprin Tab Stemetil MD

?bppv,migraine

Rx Sitoapaldi + Honey Sanjivani vati 2tid Sudarshan ghanvati 3tid SH tab 2bd Shadbindu oil daily nasya.

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