Otologic Manifestations of Migraine

In this episode of BackTable ENT, Dr. Walter Kutz interviews otologist Dr. Hamid Djalilian about the link between the hearing / vestibular disorders and migraines.

First, Dr. Djalilian shares how he discovered the connection between Meniere’s disease and migraines when he noticed that many Meniere's patients described migraine-like triggers and migraine-like symptoms. He then decided to treat his Meniere’s patients with migraine medications, such as nortriptyline, topiramate, and verapamil and encouraged them to follow migraine diets. He found that many patients’ symptoms and hearing improved after this regimen. This discovery led him to conduct multiple novel research studies about using migraine medications to restore hearing and balance in Meniere’s patients.

Next, Dr. Djalilian describes his migraine medication dosage for Meniere’s patients. He starts patients off with 10 mg of nortriptyline for 2 weeks and then increases the dosage by 10 mg every week for six weeks. For patients with very frequent vertigo, he will start the patients on 25 mg of nortriptyline for 2 weeks and then increase the dosage by 25 mg every 2 weeks for 6 weeks. For topiramate, he will start the patient on 25 mg and increase the dosage by 25 mg every week for 6 weeks.

Additionally, he recommends that patients take Vitamin B2 and magnesium supplements. He also emphasizes that lifestyle modifications (sleep hygiene, diet, hydration, stress management, etc.) are the most important part of resolving migraines and Meniere’s disease. He encourages all his patients to keep a journal in order to find their migraine triggers in order to resolve their symptoms more effectively while on medication.

Next, he explains how he trains advanced practice providers, like NPs and PAs, to help manage his high volume of Meniere’s patients. He makes sure they are comfortable with taking a comprehensive history and explaining medications and their side effects. During the time they spend with him, he also provides them with personal talks, handouts, and book recommendations. Finally, he trains them to perform intratympanic steroid injections. Working with NPs and PAs allows him to care for patients more efficiently and frees him up to see complicated patients.

Finally, the doctors discuss Dr. Djalilian’s new research about the link between persistent postural perceptual dizziness and migraine as well as the ability of migraine medication to treat the former.