Timothy C. Hain, MD of Chicago Dizziness and Hearing
Page last modified: June 6, 2018
Just published in 2018 is "Dizziness and Vertigo aross the Lifespan", edited by Gleason and Kesser. We wrote a chapter on Migraine associated vertigo. Another chapter is in press.
As of May, 2018, we have also just published (or nearly published) two new articles on bilateral vestibular loss in Frontiers.
A new treatment for chronic migraine has hit the "streets". The first drug in this new category, erenumab (aimovig), was approved in May of 2018. There are 3 more agents waiting for approval. They are generally "anti-CGRP antibodies" (Giamberardino et al, 2016). We expect this category will be very expensive, but when covered by health insurance, potentially a game changer for a small group of refractory migraine patients. Here we are talking about 10% of refractory migraine patients. The results so far in patients with mild migraine suggest it is similar to botox in how well it works -- not that impressive. So perhaps a better botox. Or it may be a dud. Lets hope for the best !
We have started the process of prescribing the first of these agents. For present CDH patients, the form to fill out and fax to us to try aimovig is here.
CDH has recently begun checking new dizzy patients where there is a reasonable suspicion of cardiac disease using a rapid techology for an ECG (electrocardiogram). The thought was that dizziness is a "sorting problem", and heart disturbances are common. We are encountering "actionable" cardiac problems in roughly 5% of our patients above 60 years of age. Examples of positive findings are atrial fibrillation, AV block, bundle branch block, many ectopic ventricular beats, and bradycardia. Some of these conditions could potentially cause death or stroke. We think that this is a reasonable and useful intake process in the "dizzy clinic".
Visual vertigo is a condition where patients are intolerant of situations where there are large amounts of visual stimulation -- examples include walking through the aisles of a grocery store, difficulties with viewing scrolling computer screens, and driving problems where the speed gets above a certain threshold (often superhighway). It is sometimes diagnosed as a migraine variant (e.g. vestibular migraine), as a psychiatric condition (e.g. PPPV), as an ocular disturbance (e.g. in patients with 3rd nerve palsies or otolithic problems), and as a reorganization to loss of vestibular sensation (e.g. visual dependence).
Some progress has been made in treating this condition by the optometry profession, through manipulation of eye-wear and visual exercises. We have recently recruited an OD to treat this condition, Dr. Marsha Sorenson. This is going well.
Dai et al (2014) reported successful treatment with a variant of motion sickness, Mal de Debarquement, with a 5 day adaptation protocol. We sent a representative of our practice to visit Dr. Dai to learn how to do this treament, and we are offering it to MDDs patients. At this writing (4/2017), we have treated 28 patients. It works reasonably well, but it requires lots of staff and patient time. See this page regarding our progress so far.
Chicago Dizziness and Hearing has the "VHIT" test machine, which is a device that quantifies the results of "head impulses". This is a new technology to assess vestibular function. It is very good in detecting unilateral vestibular loss, such as due to tumors or vestibular neuritis. It is also modestly useful in assessing vestibular compensation - -persons who are uncompensated have "overt" saccades, and those who are compensated have "covert saccades".
We also use the VHIT to follow patients with bilateral vestibular impairment, to decide whether or not they are getting worse. It is far less stimulating that the rotatory chair, and we sometimes use it in place of VENG/R-chair in motion sensitive persons. Again it is a little tricky as people can improve on the VHIT (due to compensation) but remain unchanged on the rotatory chair (when one considers the entire vestibular response). We have also found VHIT somewhat helpful in occasional situations where a "tie breaker" is needed between ENG and rotatory chair.