Falls, Dizziness, Diagnosis, and Medications
Migraine, Meniere’s Disease (MD), and vestibular migraine (VM) likely share a common pathogenesis. Unfortunately, there is no “gold-standard” lab test to identify the “correct” diagnosis. Further, the audiologist, otolaryngologist, or neurologist (or other) must interpret the case history, physical findings, and test results to establish the differential diagnosis. Unfortunately, overlapping terms may be used to indicate the same (or highly similar) phenomena (Beck et al, 2013). Beck et al (2015) report that “migraine associated dizziness, vestibular migraine, benign recurrent vertigo, migraine related vertigo, migraine-related dizziness, migraine-associated vertigo, migraine-associated dizziness, migraine-related vestibulopathy, vertiginous migraine, and migrainous vertigo (and more) appear to share a common pathogenesis and similar test results, and arguably, each term may be applied to the same set of symptoms.”
Compounding the difficulty of inexact and non-exclusive diagnosis of dizziness, are the issues of increasing dizziness with age and the presence of multiple prescription drugs that increase the likelihood of falls in the older population.
Harun and Agrawal (2015) evaluated 292 patients who presented in their neurology clinic for dizziness from July through December, 2013. The average age of their patients was 53 years and two-thirds of all patients were female. They reported the use of “fall risk increasing drugs” (FRIDs) was apparent in some 40 percent of patients. Thirty-nine percent of their patients were on psycho-tropic drugs (drugs acting on the central nervous system), 37 percent were on anti-hypertensives, and 8 percent were on narcotics. In total, 34 percent were on two or more FRIDs and the most common primary diagnosis was Migraine (in 43 percent) and Meniere’s Disease (in 19 percent).
Of note, older patients were statistically significantly more likely to be on multiple FRIDs (primarily anti-hypertensives and narcotics). The authors report dizziness “affects one-third of Americans age 40 years and above and the prevalence increases with advancing age….” They report dizziness may come from multiple and co-existing etiologies including; vestibular disorders, cardiovascular disease, metabolic issues, orthostasis, psychiatric disease and multiple medication (i.e., polypharmacy) use. Harun and Argawal report an earlier study of ambulatory people age 65 years and older found 44 percent of males and 57 percent of females take five or more medications.
For More Information, References, and Recommendations
Beck DL, Petrak MR, Smith AG. (2013) Overview 2013: Migraine, Meniere’s Disease and Vestibular Migraine. Audiology Today 25(2):54-56.
Beck DL, Petrak M, Madell JR, Cushing SL. (2015) Update 2015: Pediatric Vestibular, Balance, and Hearing Disorders. Hearing Review.
Harun A, Agrawal Y. (2015) The Use of Fall Risk Increasing Drugs (FRIDs) in Patients with Dizziness Presenting to a Neurotology Clinic. Otology & Neurotology 36(5):862-864.