A 21-year-old college student has had episodes of dizziness that last for 12 to 48 hours. She describes a sensation of spinning, accompanied by nausea, dry heaving, and impaired balance. She has no vision loss or neurological deficits before, during, or after the events.
Two episodes occurred during her second semester in college and at least three more during her sophomore year. They increased in frequency during the first semester of her junior year. The episodes are often preceded by stress, but they have also occurred without any precipitating event. Her most recent episodes occurred during the week of her midterm examinations. She said that she had been under stress and had not been sleeping well that week.
During one episode, she fell while walking to class. A friend accompanied her to the student health office, where she was seen and transferred to a nearby emergency department. The results of a brain CT scan were normal, and she was given a prescription for meclizine to take as needed. She used it at the onset of her next two episodes, but it was not helpful.
She decided to move back home for a semester and is taking two online classes. While living at home, she had one episode of dizziness, which was accompanied by a mild headache.
The patient is otherwise healthy, but she is very upset about her dizziness and is concerned about her ability to graduate from college.
Medical and family history
When she was a child, she had episodes of cyclical vomiting and received a tentative diagnosis of abdominal migraine. The episodes had stopped by the time she was 13 years old. She does not drink alcohol or smoke and has not used any recreational drugs. She does not take over-the-counter or prescription medications except for meclizine.
Her father has Ménière disease. Her mother has a possible diagnosis of lupus.
The patient appears well-nourished and is no acute distress. She is alert and cooperative. No skin discoloration or lesions are evident, and the results of cardiac, respiratory, and abdominal examinations are normal.
She has normal extraocular movements with no facial asymmetry. Pupils are equal, round, and reactive to light with no asymmetry or papilledema. Motor strength is 5/5 and reflexes are intact in bilateral upper and lower extremities. Coordination is normal without ataxia or dysmetria. Sensory examination is normal to light touch, pinprick, vibration, and proprioception, and gait is normal.
A brain MRI scan with contrast is normal. The results of a hearing test are also normal.
1. Çelebisoy N, Gökçay F, Karahan C, et al. Acetazolamide in vestibular migraine prophylaxis: a retrospective study. Eur Arch Otorhinolaryngol. 2016;273:2947-2951. doi: 10.1007/s00405-015-3874-4
2. Nevoux J, Barbara M, Dornhoffer J, et al. International consensus (ICON) on treatment of Ménière's disease. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(1S):S29-S32. doi: 10.1016/j.anorl.2017.12.006
3. Ghavami Y, Haidar YM, Moshtaghi O, et al. Evaluating quality of life in patients with Meniere’s disease treated as migraine. Ann Otol Rhinol Laryngol. 2018;127:877-887. doi: 10.1177/0003489418799107