Migrainous vertigo seems to respond to intravenous infusion of a high dose of corticosteroids, according to a report in the latest issue of Headache by a group of Indian doctors. Two of their patients had intermittent episodes of severe vertigo and two had chronic vertigo. All four respond to infusions of 1 gram of methylprednisolone. One require 3 infusions, one needed 2 and in another 2 vertigo stopped after a single infusion. We routinely use corticosteroids for severe migraine attacks when other medications fail. While occasional (once or twice a month) use of corticosteroids is relatively safe, frequent or daily intake of corticosteroids (besides methylprednisolone, these drugs include prednisone, prednisolone, and dexamethasone) can lead to dangerous side effects. It is possible that oral corticosteroids will produce a similar effect as an infusion and may be worth trying when nothing else helps relieve the vertigo.
Read MoreTreatment of menstrual migraines often is more difficult than of non-menstrual attacks. A double-blind study by Marcelo Bigal and his collaborators just published in Headache shows that a combination of 10 mg of rizatriptan (Maxalt) and 4 mg of a steroid medication, dexamethasone (Decadron) is more effective than either drug alone. Both drugs are effective in treating many refractory migraine attacks (although I usually use 8 mg of dexamethasone), this is the first trial of two drugs together. While the results are not very surprising, the study may lead to wider acceptance of combination therapy and better relief for many women. While in the past the emphasis was placed on finding a single drug to treat a disease, in recent years combination therapy has become a standard approach in many conditions. Treximet, a combination of sumatriptan (Imitrex) and naproxen (Aleve) was also shown to be better than either of the two ingredients alone.
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