Managing Meniere’s Attacks

​Meniere’s disease is triggered by fluid buildup in the inner ear.  It causes unpredictable attacks of vertigo and tinnitus that can interfere with daily activities.  While there is no cure for Meniere’s disease, most people can manage attacks with medication and by avoiding triggers.

Managing Meniere’s Attacks
By Pierre Mouchette | Bits-n-Pieces

Meniere's disease is caused by fluid buildup in the inner ear, which regulates hearing and balance.  People with Meniere’s disease have sudden, unpredictable attacks of dizziness (vertigo), nausea, and headaches.  They may also experience intermittent hearing loss and ear ringing (tinnitus).  These attacks can last for hours, making it difficult or even impossible for people to do everyday activities.  Because attacks can start without warning, it is easy to be caught off guard.
 
The following are helpful methods to use to help manage Meniere's attacks.
Avoid Things That Can Trigger Attacks
Specific actions or events can trigger Meniere’s attacks or make attacks last longer.  These triggers can be different for different people, but the most common are:

• Bright lights or flashes of light
• Exposure to allergies, like pollen and dander
• Foods containing tyramine, like smoked meats, beer, and pickles
• High-exertion activities or sudden head movement, including tilting your head back
• Smoking
• Stress
• Strong smells, like smoke or cleaning products
• Travel
• Weather changes, like barometric pressure and humidity

Avoid these triggers when possible.  During your next attack, see if anything specific makes your symptoms worse.  You can also time your attacks to see if they last longer when doing particular activities.  Doing this will help you identify your triggers to avoid them in the future.
 
Keep Emergency Medications With You
Many people take medication daily to keep fluid from building up in the inner ear.  But people also need medication to get through the attacks.  These are called emergency medications.  Some people need two or more emergency medications during spells.  Some common ones include:

• Clonazepam (Klonopin)
• Diazepam (Valium)
• Promethazine (Phenergan)
• Zofran (ondansetron)

Attacks are unpredictable, so it is crucial to be prepared.  Have your medication with you always, especially if you are not at home.  If feasible, keep an emergency kit in your car, office, or any location where you spend much time.
Family and friends naturally want to help when you are having an attack, but make sure they do not accidentally give you medication that can worsen your attack.  Let your friends and family know that the following medicines can worsen your symptoms:

• Antacids, like calcium carbonate
• Aspirin
• Caffeine-containing medications, like Excedrin
• Ibuprofen (Advil, Motrin)
• Naproxen (Aleve, Naprosyn)

 
Limit Salt, Alcohol, And Caffeine Intake
Research data reveals that specific foods and substances will worsen attacks by increasing fluid buildup in the inner ear.  Follow these rules of thumb:

• Avoid caffeinated and alcoholic drinks if possible.
• Only eat 1 to 2 grams of salt per day.

Nicotine and monosodium glutamate (MSG) can also increase fluid buildup, so avoid them when possible.
 
Do Not Overlook Your Physical Safety
A Meniere’s attack may come with the risk of physical injury.  You may lose your balance and fall or have an accident driving during an attack.  When symptoms start, find a safe place to sit or lie down.  It is beneficial to locate a spot in or near the places you spend a lot of time in.  If you are driving, pull over at the first sign of an attack so you do not get into an accident.
Changes in barometric pressure could trigger an attack.  Before you go out, check the weather forecast and keep a weather or barometer app on your phone.  If you see a storm or rain alert, consider changing your plans and do not get behind the wheel.
 
Learn To Recognize Your Aura
Many individuals with Meniere’s disease get an aura before an attack.  Auras are mild symptoms that can warn you that you are about to have an attack.  You might miss your aura if you are not paying attention.  Aura symptoms include:

• Ear pressure
• Feeling off balance
• Feeling uneasy
• Headache
• Lightheadedness
• Sensitivity to sound

Understanding your aura can help you prepare, whether getting off the road or ensuring your medication is on hand.  Once your aura starts, you should:

• Find a safe, comfortable place to rest.
• Keep your eyes shut or focus them on an object that is not moving.
• Move and turn your head slowly.
• Take your emergency medication.

 
Focus On Your Mental Health
There is no cure for Meniere’s disease.  But together with treatment, you could go years or even decades without having an attack.  Studies prove that with treatment, many people with Meniere’s disease may go about their usual activities.
While this is good news, it is crucial to understand that attacks are stressful.  Being worried about having an attack also adds to stress, as does the worry of losing your hearing.  Many patients with Meniere’s disease report higher levels of anxiety and depression.  So it is crucial to address mental as well as physical health and consider the following:

• Discuss with your healthcare provider other treatment options
• Joining a support group
• Working with a therapist