Q: My wife is suffering from pain at the back of the neck on the right side. The pain starts behind the right ear and continues up to the back of the neck's right side. At times she has a whirling sensation and complaints that everything around her is revolving. Her right ear has a sensation of fullness, which irritates her. Couple of months ago, this was also associated with severe headache and occasional vomiting. She is very depressed with all these problems. Our family physician diagnosed it as vertigo and prescribed Vertin 16mg three times a day during severe conditions. He also suggested Betacap 40 TR, Tryptomer 25mg one each a day for a month. The headache stopped after this. Then the doctor asked her to reduce the dose of Vertin gradually to 8 mg a day for over 2-3 months. He also suggested stopping it if there is no problem. She stopped for a month because she had none of the above problems. After stopping, similar symptoms appeared again, but without the headache. The doctor prescribed Vertin again, but there was no relief. She consulted an ENT specialist, who suspected frontal sinusitis & took a CT scan. Although the CT scan report shows normal, the doctor suggests a surgery to rectify the frontal sinusitis. We consulted another ENT specialist, who referred us to a neurologist. The neurologist attributed all the symptoms to a kind of migraine, suggesting the following medicines for a month - Zapiz (Clonazepam) 0.25 mg during nights, Trilol SR-40 (Propranolol HCL) 1/2 each in the morning & night, Libotryp (chlordiazepoxide & amitriptyline hydrochloride) 1 during nights. It has been a week since she has been taking these tablets, and we are waiting for the effect of these. Now we are confused whether to go to a physician, ENT specialist or a neurologist. Please suggest a suitable medical treatment for the above problem.

A:Vertigo (which is commonly described as spinning, rotating or dizzy sensations) can have many causes and migraine is certainly one of them. However, when associated with migraine, it is closely related with headache. Your symptoms of severe headache and vomiting (especially if pulsatile) raise the possibility of migraine and the close temporal association of vertigo with it can be explained by migraine itself. In that case your wife is likely to benefit from preventive treatment of migraine, which has been advised. However, as I have mentioned earlier, vertigo can be due to other causes as well and therefore these need to be excluded. This is particularly true if the vertigo is present with new onset headache (that is, the headache which your wife experienced started only recently and previously there was no history of headache) and more so when vertigo is occurring without headache (as is the picture now). Frontal sinusitis is unlikely to cause vertigo. It can cause headache but that is usually frontal and not at the back of head. Evidence of sinusitis can be found on CT in many normal persons and only becomes significant when it can be correlated with clinical symptoms. Vertin is an anti vertigo agent with specific indications and not to be used indiscriminately. I think you should consult a good neurologist.