First attack around 40 years of age. Without warning, sudden onset of vertigo with nausea and vomiting, no ear congestion, no hearing loss, no headache, must lie down to rest, significant sound and light aversion, symptoms resolve completely within 2-3 days. It occurs about once a year at the age of 40-50, with exertion, poor rest, and work stress as possible triggers. Each attack is treated with infusion. In addition to such severe episodes, I often had dizziness in general, and when I got dizzy, I received fluids. I thought that the infusion could relieve the symptoms and was convinced that it was caused by insufficient blood supply to the brain. There were no episodes between the ages of 50 and 62 (retired at 50). Not long after sitting down, the patient told me she was also a doctor, retired at 50, and was very, very busy at work before she retired. After retirement, it was much easier and the vertigo did not return for 12 years. After she turned 62, she started to have two attacks, one at the age of 62 and another one a month ago. The symptoms during the attacks are very similar to the ones I had in my 40s and 50s, but the vertigo is worse than before. There was obvious anxiety, easily irritable, easily worried, and easily nervous, but he firmly denied it himself, and fortunately, an understanding daughter accompanied him to the clinic. There were somatic symptoms such as head swelling and pain, feeling that the head was not overflowing with blood, and soreness and discomfort in the neck. No hearing loss. Had motion sickness. Denies history of migraine. Denies family history of migraine or vertigo. Have a history of hypertension and are taking Dextran. Have hyperlipidemia, on Lipitor. Also already taking aspirin for primary prevention of cardiovascular disease. The following findings were brought: head MRI showed a small amount of white matter lesions, cervical MRI had mild disc kyphosis, carotid ultrasound had carotid atheromatous plaque, and TCD showed no abnormalities. Examination: normal oculomotor examination, normal gross audiometric examination, normal ataxia, normal movements and reflexes, no pathological signs were elicited. Diagnosis: 1. probable vestibular migraine; 2. anxiety state; 3. hypertension; 4. hyperlipidemia Treatment: 1. explanation: inform the patient that her 20-year-long recurrent vertigo attacks are the same as some people’s recurrent migraine attacks, and that such attacks are not caused by cerebrovascular disease or cerebral blood supply deficiency, and are not related to carotid atheromatous plaque, white matter lesions on MRI of the head, or cervical spondylosis. It is also not related to cervical spondylosis. Because the number of attacks is very few, there is no need to use preventive medicine, and it is enough to use medicine to stop dizziness and vomiting during the attacks, or to apply medicine for acute attacks of migraine. There is no need for infusion treatment. The fact that she got better from her vertigo attacks in the past is not due to infusion, but she will still get better without infusion, which is a process that can naturally relieve. 2. Tell the patient that her headache and neck discomfort are the same as her anxiety, and suggest to see the psychology department. 3, primary prevention of cardiovascular disease: blood pressure control, statin, aspirin. This morning’s patient, accompanied by an understanding daughter, when I explained the patient did not understand (in fact, not do not understand, is not accepted, because with the previous other doctors say completely different, and she has long accepted the views of other doctors), the patient’s daughter on the side has long listened to understand (the patient’s daughter has not been indoctrinated before what, although not studying medicine, as long as have a certain logical thinking (The patient’s daughter had not been indoctrinated with anything before, although not a medical student, as long as she has some logical thinking ability, she can understand at first hearing). I said while looking at the film on the light box: the head MRI brain white matter does have some lesions, these lesions are mainly related to hypertension and age, the lesions are also very few, do not worry, these lesions have nothing to do with your dizziness; cervical spine MRI is also not normal, the disc has a back bulge, but people will be aging ah, and also has nothing to do with your dizziness. While reading the carotid ultrasound report, he said, “There is plaque in the carotid artery, and at your age, you have hypertension and hyperlipidemia, so it is not surprising that you have atherosclerosis, but this has nothing to do with your dizziness either. You are now using antihypertensive drugs, statin and aspirin for primary prevention of cardiovascular disease, which is very good, and continue to use them in the future to reduce the risk of cardiovascular disease when the risk factors are well controlled. Patiently explaining to the patient over and over again, the patient still had difficulty accepting it and kept asking questions back, especially when I said she had anxiety and that some of her symptoms were related to anxiety, the patient was very reluctant to accept it. The patient’s daughter couldn’t look away and later she helped me to explain to the patient together. It was so nice, otherwise I would have spent more time.