I’ve suffered from balance issues since late 2018. Despite tests, neither my GP nor an ear specialist can help. The dizziness coincides with a stiff neck and blurred vision (in the form of pixelated crescents, which typically disappear after 15 minutes) at the same time as the balance problem.
Bob Pimlott, Rutland, E. Mids.
Your symptoms are typical of vestibular migraine — essentially a migraine where the main symptom is vertigo, or lack of balance, accompanied by dizziness.
Although migraine is usually associated with headaches, sometimes they cause no pain at all.
Vestibular migraines have been known about since the late 1800s, but there have been only a few studies and no definitive tests for them, which helps explain the relatively poor awareness of the condition — and may help explain your lack of diagnosis.
Typically, migraine headaches are preceded by an ‘aura’, often causing visual disturbances such as bright spots or pixelated shapes, like the crescents you describe seeing.
An aura is not always visual — some people may experience a hallucination, a particular smell, or a heavy numb feeling in one arm, for instance.
Although migraine is usually associated with headaches, sometimes they cause no pain at all
In vestibular migraine, the dizziness tends to come before the visual disturbance, and most patients do not experience headache. In your case, it may be that the neck stiffness is your version of the headache.
The treatment is two-fold: medication for acute attacks and medication for prevention, which may be necessary when bouts of vertigo are frequent (more than twice a week for more than four weeks in a row).
The medication depends on the individual and how long the attacks last. Typically, people who experience longer attacks are prescribed drugs to suppress the balance mechanism system (involving the structures in the inner ear).
These drugs include antihistamines, benzodiazepines, and antiemetics (nausea pills), which essentially work on different mechanisms. They are effective, although benzodiazepines carry the risk of causing drug dependency.
As your attacks last only 15 minutes, treating the acute symptoms with oral medication is not really an option, as any drug wouldn’t be absorbed, let alone be able to act, before they’re over.
But if your attacks are frequent, then drugs to prevent the migraines are an option. These include beta blockers (used in the past to treat high blood pressure), tricyclic antidepressants, or one of a group of anti-convulsant drugs such as topiramate, which work on the neurological pathways involved in migraines.
I suggest discussing this with your doctor.
A family member who is 40 is experiencing difficult menopausal symptoms, but has had oestrogen-positive, low-grade ovarian cancer and is worried about recurrence if she takes hormone replacement therapy (HRT). I should be most grateful to know what is the current research and opinion?
Sylvia Gilbert, Salisbury, Wilts.
About a fifth of women diagnosed with ovarian cancer are under 40 and the treatment — often surgery to remove both ovaries as well as chemotherapy — can trigger an early menopause (the ovaries are responsible for producing the hormone oestrogen). HRT can help, easing symptoms such as hot flushes and fatigue.
The good news is that currently there is no evidence to suggest that HRT after treatment for ovarian cancer raises the risk of the disease recurring; indeed, there is some evidence that it may improve survival.
One analysis of 350 women with hormone-positive ovarian cancer given HRT showed no difference in survival rate, incidence of breast cancer, stroke or heart attack when compared to a group of ovarian cancer patients who hadn’t tried HRT.
So while there has been speculation that oestrogen-positive cancer (which is stimulated by the hormone) might recur if the woman takes HRT, the general agreement based on the evidence we have is that it’s safe to prescribe it.
Your relative would be best advised to speak to her specialist about going on to HRT.
Write to Dr Scurr
Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email: [email protected] — include contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context.
Consult your own GP with any health worries.
In my view: Doctors set the best example for having Covid jabs
What better evidence is there for the effectiveness of Covid vaccines than the vast majority of doctors having had them?
A survey from the Royal College of Physicians (which represents hospital doctors) shows 99 per cent of members have had two vaccines and 96 per cent have had all three.
Many doctors are now facing the ethical challenge of looking after patients who have decided not to be vaccinated. The task is to engage with these people and try to reverse their misconceptions.
The most common reason for turning down the jab is mistrust of the science and the efficacy of the vaccines, with fear that the rapid research and manufacture means they can’t have been fully tested.
These fears are unfounded given the highly detailed and respected process of development. But how do we persuade people otherwise?
The science of immunology and virology, and the data, are complicated. So perhaps we should rely on the knowledge that 99 per cent of hospital specialist physicians have chosen to be fully vaccinated.