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MAV vs. Meniere's

  • Here's a summary I made of a long article on MAV from the Tampa Bay Hearing & Balance Center. Hopefully it will give some clues to those who are trying to determine if their vertigo is MAV or purely Meniere's.

    I've put it in a MAV vs. Meniere's type format, since they contrasted the two for much of the article. My summaries/interpretations are that of a laymen, and a very lay man at that. So you can reference the full article for yourself here:


    MAV vs. Meniere’s


    “[Hearing is one of the bigger differences] between MAV and Ménière's. The hearing loss of migraine occurs simultaneous with the vertigo, whereas in Ménière's, it tends to occur hours to days ahead of the vertigo.”

    Auditory issues - both ears vs. one ear:

    MAV, auditory symptoms during episodes usually affect both ears at the same time.

    Meniere’s: Auditory symptoms occur in just one ear at a time. (Excluding bilateral Meniere’s)


    MAV: During vertigo episode there is seldom spontaneous nystagmus, and very little nystagmus.

    Meniere’s: Nystagmus is easily observable.

    Direction of Visual Spinning:

    MAV: Usually vertical.

    Meniere’s: Typically horizontal.

    (In acute viral vertigo syndrome, nystagmus is more typically slightly rotary but can be horizontal.)

    Duration of Vertigo

    Not always a telling difference between the two. Both commonly last hours. Minor episodes of both MAV and Meniere's can be short lived.

    In both, changing body/head positions can make it worse.

    However there is an instructive difference:

    MAV: Vertigo can last days. (And there is sometimes a rocking sensation that may last for many weeks to months.)

    Meniere’s: Vertigo does not typically last more than 24 hours.

    Timing of Associated Symptoms:

    MAV: Ear issues (hearing loss or tinnitus) tend to occur at the onset of vertigo.

    Meniere’s: Hearing loss usually worsens as tinnitus and pressure increases in the hours to days prior to onset of vertigo.

    Head pain:

    MAV: No headache required to be diagnosed with MAV. But almost all MAV patients have had a form of migraine history and a high percentage have a family history of migraine headache. “Consider that in migraine, the aura may occur without headache. It should then not seem strange that vertigo may occur without headache.”

    Meniere's: The article does not discuss Meniere's headaches (unless I missed it).



    “Treatment is usually straightforward, but can be quite complex. When the episodes are quite infrequent and not terribly severe, no treatment may be necessary. A good patient education may suffice. In our experience, a period of migraine associated vertigo may last months to a few years, but is seldom a recurring problem for more than a year or two.

    For those with symptoms which recur in a disruptive pattern, we commonly find trigger issues which are manageable. For example, high stress which affects sleep patterns is common. For those patients, medications which promote sleep and improved stress management are often helpful. Antidepressants can be helpful…

    Many suggest dietary manipulation such as eliminating chocolate, hard cheeses, alcohol and monosodium glutamate but our experience is that these are of uncertain value. Of course, alcohol can itself be a headache trigger, but we do not see it is MAV trigger.”

    Meniere’s: (no treatment discussion, since it’s not a Meniere’s article).

    Conclusion: “In summary, when recurring vertigo has a defined onset and a duration of hours to days, especially without ear-specific symptoms, migraine is a common cause. To be more definitive, a careful history and investigations of hearing and balance function and imaging of the brain are required.”
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