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.

All Answers

Assess for presence of spondylosis. Teach him neck exercises


Rx tab vertin 16 mg TDs *10 days Then bd *5days Then od*5days Tab gemver bd*5days Tab stemetil MD TDs*5days Tab pan 40 mg od Rest.... Adv cervical x-ray

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


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

It is not mentioned about 1) X-RAY cervical spine.2) any h/o middle ear infections.

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.

Minner’s disease Tab fluranil 1 bd then review

Cervical ho sakta h ?

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