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Have Vascular Headache With Imbalance Problems. Is It Safe To Take Flunarizine Or Betahistine?

Posted on Mon, 11 Mar 2013

Question: Dear doctor

I want to know which is the best medicine for vestibular disease.flunarizine or betahistine?

My doctor has prescribed me sibilieum for vestibular disease.
What are the side effects of both these medicines
To brief it, i was diagonised with vascular headache with imbalance problems
all my reports came normal. Except a Doppler test which read that i have a mild disturbed blood flow in my left ear
Kindly advise

Answered by Dr. Naveen Kumar Nanjasetty (1 hour later)

Hi

Thanks for posting the query

The best medicine for the vestibular disease is betahistine. Flunarizine (sibelium) is commonly used for treatment of Migraine and occasionally in the occlusive peripheral vascular disorders.

With this improper history it is difficult to come to a conclusion as to what exactly your problem is. Migraine can also present with recurrent headache associated with balance problems known as XXXXXXX There can be reduction in the blood flow to the head, giving rise to pulsatile headache and dizziness. Secondly, vestibular disorders (such as labyrinthitis) include dizziness, hearing loss and tinnitus. Hence both are different entities and the treatment is also different.

If you can elaborate your problems I will be able to help you in a better way.

Hope I have answered your queries; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naveen Kumar Nanjasetty (11 minutes later)

Thanks doctor,

I have a vague giddiness whenever I have imbalance .

Based on my Doppler effect report, which read that I have suboptimal blood flow in my left side of my ear

My ent specialists conducted vemp test, position test, bser test, eeg test along with brain MRI and mra angiogram and venogram

All reports came normal, so my ent specialists suggested me that I have initial stage of migraine with imbalance problems. She also suggested that I take vertin in case of dizziness

Hope I explained you in detail doctor

Answered by Dr. Naveen Kumar Nanjasetty (29 minutes later)

Hi

Thanks for writing back and a detailed history

So my guess was right, you are having classical migraine. Flunarizine is the drug of choice for your problem. Flunarizine alone will be enough to take care of your problem. You can also try taking vitamin B-complex and pain killers (only when required). I don't think so you will require any other medicines apart from these.

My suggestions to you are:
1. Drink plenty of water
2. Consume plenty of fresh fruits and vegetables
3. Every day try to take food at the same time
4. Sleep for at least 7-8 hours/day
5. Avoid stress/alcohol/smoking/cheese/chocolates/ice cream/canned food
6. Avoid prolonged exposure to sun/loud sounds/strong perfumes

I wish you good health

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naveen Kumar Nanjasetty (18 hours later)

Dear doctor

Many thanks for the clear reply

I have only one question

All the reports came out normal, except for the Doppler effect which read that I have suboptimal flow in my left ear.

Is that not a vestibular problem rather than a classic migraine? I never got headache as that come in migraine.

And hence is that the medication should be for vestibular disease rather than for migraine?

apologies for asking such a basic level question but my health symtoms make me worry a bit and want to ensure that I am correctly diagonised with correct medications

Extremely sorry

Please advise

Answered by Dr. Naveen Kumar Nanjasetty (5 hours later)

Hi

Welcome back

The MR Angiogram done on you is more superior compared to that of Doppler. It shows the blood flow even to the minute blood vessels, better than the Doppler. If the MR Angiogram is normal, then you don't have to worry.

As mentioned in my previous response, vestibular problems will also be associated with reduced hearing and tinnitus. Secondly, for migraine there are no specific tests, it is diagnosed based on the history. At present, you can start with Flunarizine (Sibelium), it is relatively safe and gives good results.

No apologies please, you can ask me any questions pertaining to your problem.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naveen Kumar Nanjasetty (1 hour later)

ElThank you doctor

That really provided me a relief

Following are the symptoms told by me to my ent specialists

1. When I lie on side. The next day I get pain on that side eye and ear
2. When I lift heavy objects. I feel the same pain
3. When I bend down and get. I get the same pain

Based on the above and some imbalance problems my ent special.st suggested that it hi a beggingdg stage of migraine

Lastly I want to knew whether migraine can be without that head throbbing pain?

Kindly advise

Answered by Dr. Naveen Kumar Nanjasetty (12 hours later)

Hi

Thanks for writing back

I am sorry, the symptoms you have mentioned now and history you gave before are quite confusing.

The symptoms mentioned in the present query is not related to migraine or any vestibular problems. It appears to be more of Temporo-mandibular joint (TMJ) related disorder. Occasionally, there can dizziness noted in TMJ arthritis associated with pain and tinnitus in the ear, which can be mistaken for ear pathology.

I don't think so Flunarizine or Betahistine is going to help you in any way. You will have to take pain killer such as diclofenac or ibuprofen, with a local application of topical pain reliever and rest for the affected joint. Avoid chewing any hard food on the affected side, eat soft food and the food has to be chewed on the opposite side. You can try this medication and give me feedback.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naveen Kumar Nanjasetty (15 minutes later)

Doctor

I am really worried now

Is tmj a dreadful disease.

What test do i need to take to confirm that disease...

Please advise

Answered by Dr. Naveen Kumar Nanjasetty (1 hour later)

Hi

Welcome back

TMJ arthritis is a minor problem and not a disease. It is inflammation of the joint in front of the ear. Please follow the instructions mentioned in my previous response. If the pain does not subside you can get a OPG x-ray done.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naveen Kumar Nanjasetty (48 hours later)

Dear doctor

My ENT specialist ordered me a HRCT temporal bone with TMJ along with special screening of PNS. The results of the same are as below,

CT TEMPORAL BONE

No significant abnormality in temporal bones

SCREENING OF PNS

1. DNS to right
2. Bilateral inferior turbinate hypertrophy
3. Paradoxical curvature of both middle turbinate
4. Mucosal thickening of both maxillary sinus with right OMC block

SCREENING OF TMJ

Subchondral erosions in mandibular articular surface of left TM joint wit. Maintained joint space

Kindly advise

Answered by Dr. Naveen Kumar Nanjasetty (10 hours later)

Hi

Thanks for writing back

Subchondral erosions could be the reason behind your earache and other symptoms. Do not worry! This is not something which is very XXXXXXX Consult a good facio-maxillary surgeon, he will be of better help to you than ENT specialist.

PNS scan shows some minimal problems totally unrelated to your symptoms, for the time being forget about the PNS and concentrate on the above problem.

Meanwhile, follow the instructions as per my fourth response, you will be definitely alright.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naveen Kumar Nanjasetty (5 days later)

Dear doctor

I consulted an facio maxillary surgeon and he advised me that there is only mild erosion and that he has prescribed the same medication you told me

Last three days. My imbalance problem is there. It is like when I walk my left leg feels like wobbling and because of that I feel uncomfortable. Though not dizzinesg

I am getting fullness like feelin in my left ear but I suspect that may be because of cold I have

In morning times. I fell complete fatigue and very tired

And sometimes I have that dizzy feeling but though not really I experience

I have stopped taking nasal prays and sibilieum . I am unable to sit silently in one place and I tend to move my left often. A sort of irritable feeling is there

Kindly advise

Answered by Dr. Naveen Kumar Nanjasetty (20 hours later)

Hi

Thanks for writing again and the feed back

Good, you can continue with the medicines prescribed by your doctor. If you feel, your dizziness is quite uncomfortable, try taking betahistine 16mg 3 times a day. Betahistine helps in improving the micro circulation and gives you relief from both dizziness and the fatigue.

Secondly, for the ear block, use saline spray and do steam inhalation, it should be alright.

Hope this answer was helpful to you.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naveen Kumar Nanjasetty (14 days later)

Hello doctor

This is in continuation to my above queries

I was asked by my general physician to go for a complete blood and my results have come

I wanted to share this result with you

1. Haemoglobin .......... 15.5 gm/dl

2. ESR ......... 15 mm/hr ( the lab report has mentioned the normal values as 5 to 15 . Is my reading a cause of concern? )

3. Glucose fasting . . . . . 102.4 mg/dl

4. Glucose pp . . . . . 116.50mg/dl

5. Urea . . . . 16.6 mg/dl (again my lad report has mentioned that normal limit is 19 to 44. Is my level of urea low? )

6. Creatine . . . 1.0 mg/dl ( is my creatine on higher side? . Last time I had a creatine of 0.8 )

7. Uric acid . . . 5.9 mg/dl

8. Liver function test reading are all normal

9. Cholestrol levels are quite high but compared to last time I have reduced my ldl cholestrol and my hdl cholestrol has increased

Kindly advise

Thanks

Answered by Dr. Naveen Kumar Nanjasetty (4 minutes later)

Hi

Welcome back

The blood tests are within normal limits, there is no cause for concern. The ESR is well within normal limits. It will be significant only when it is above 80mm to rule out granulomatous diseases such as tuberculosis, sarcoidosis, etc.

Cheer up its perfectly normal.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar