Some researchers felt that migraine was all that was needed to cause a Meniere attack, and others thought hydrops was the entire cause. While this battle was going on in the literature, I continued to see hundreds of people with Meniere’s disease.
A lot of them had migraines; more had headaches that were not quite bad enough to be migraines, and some had no migraines at all. Yet all had the same attacks. One patient especially bothered me. He had a very rare vasculitis, an inflammation of the arteries in the head causing strokes. He also had typical Meniere’s attacks, and these happened when the vasculitis flared up. It was very unlikely that he was unlucky enough to have two completely separate but rare problems. Somehow the vasculitis was causing the attacks. What really bothered me was that the vasculitis affected all of his arteries, but only one ear had the attacks, just like most people with Meniere’s disease. This must mean that he had hydrops in that ear, and it was the vasculitis that set off the spells.
I started to pay attention to vascular risk factors in people with Meniere’s disease. Smoking, diabetes, high blood pressure, heart attacks, strokes—all these things indicate vascular problems. As time went by it became clear that everyone with Meniere’s disease had one or more vascular disorders too.
Another spectacular case came in not long after. Like everyone else he had the usual Meniere attacks in one ear, but while I was examining him, I noticed he was getting sweaty and going gray. I realized that he was having a heart attack in my clinic! We had to rush him down with a cardiac team to the emergency room, and fortunately he survived his bad experience. Another patient was a heavy smoker who had already had a couple of strokes and heart attacks, but no migraine at all. His spells stopped after he stopped smoking and we treated his vascular disease.
This meant Meniere’s disease required two hits to cause an attack. Everyone with Meniere’s has hydrops in the affected ear, and all of them have a vascular disorder that affects blood flow in the head. The hydrops explains why the attacks keep happening to just one ear, and the on-and-off effects of vascular disease explains the time course of the attacks. In the next post, I’ll go show you what happens during an attack.