Migraine is a common and debilitating neurological condition that affects millions of people worldwide. Many people say “I have migraines” However, that refers to migraine being an acute condition – when rather it’s a chronic condition that has acute attacks. Migraine disorder causes migraine attacks. One type of migraine attack (the acute presentation of migraine the neurological disorder) that is often overlooked is the “let down migraine.” This type of migraine attack is triggered by a sudden drop in stress levels after a period of high stress. In this blog post, we will discuss let down migraine attacks in more detail, including what they are, what causes them, and how they can be treated.
What is let down migraine?
A let down migraine is a type of migraine that is triggered by a sudden decrease in stress levels. This can happen after a period of high stress, such as during a busy work week, a major project, or a significant life event, such as a wedding or the birth of a child. Once the stressful period is over, the sudden drop in stress can trigger a let down migraine.
A significant decrease in stress from one day to the next, within 6 hours of the reduction, and Increase the likelihood of migraine attack to happen (1).
Symptoms of a let down migraine attack are similar to any other migraine attack you may have and can include:
- Headache: A severe, throbbing headache that can last for hours or even days.
- Dizziness: A significant increase in dizziness, vertigo, and imbalance
- Nausea and vomiting: Many people with migraines experience nausea and vomiting.
- Sensitivity to light and sound: Migraine sufferers may become sensitive to light and sound, making it difficult to be in bright or noisy environments.
- Fatigue: A let down migraine can leave sufferers feeling exhausted and drained.
- And any other migraine symptom that you may experience!
What causes let down migraine attacks?
The exact cause of a let down migraine attack is not well understood. However, it is thought that the sudden drop in stress levels can trigger changes in the brain that lead to a let down migraine. Stress hormones, such as cortisol, can also play a role in triggering migraines, and a sudden decrease in this stress hormone can trigger a let down migraine.
If you know you’re going into a period of high stress, you may be at a higher risk for a let down attack. If this is the case, talk to your healthcare provider about treatment options, like pre-treating for an attack you know is impending.
How are let down migraines treated?
There is no cure for migraines, but there are several treatment options available to help manage the symptoms. Treatment options for let down migraines include:
- Over-the-counter pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, can help relieve the pain of a migraine. Be careful with these, are they can lead to medication overuse headache is used more than 9 times in 30 days!
- Prescription medication: Triptans, CGRP’s, and other medications exist to help relieve the symptoms of a migraine.
- Lifestyle changes: Lifestyle changes, such as getting regular exercise, practicing stress-reduction techniques, and getting enough sleep, can help reduce the frequency and severity of migraines.
- Alternative therapies: Alternative therapies, such as acupuncture, massage, and cognitive-behavioral therapy (CBT), can help manage the symptoms of migraines.
All of these can be used for pre-treatment. When you’re in a period of high stress, and you know it may end soon, for instance if you’re a student at the end of the semester (or your child is) ask your doctor what you can take as the come down period approaches. This could be anything from using your neuromodulation devices to prescription medications to ensuring your reduce your own personal stress level. It’s incredibly person dependent, so you should be sure you know what you need during high times of stress.
Remember, you cannot give from an empty cup – a cliche, I know. But, really, you need to make sure you fill your own personal cup with whatever makes you happy, whether that’s yoga, meditation, a walk, exercise, art, asking for support, and more!
3 Tactics to manage let down migraine
One: Fill your cup first. You cannot give from an empty cup, and when one thing happens, it tends to all break down at once. We all know the quote ‘when it rains it pours,’ right? Yes. So, when something stressful happens whether it’s directly or indirectly to you, be sure to make time for yourself for something that feels good to YOU!
Two: Pretreat your migraine attack. When you know the letdown period is about to come, treat the attack. If you’re planning a wedding, treat the day before and day of the wedding. If you’re going through something hard with your family, be mindful of when the ‘let down’ may come and practice getting
Three: Keep up with your routines. When life gets hectic, we start to drop the little things first. Why we do this, I don’t know, BUT I know that we start to let the things in our own lives slide when the rest of life gets tough. So, make a concerted effort to keep up with your workout, food, hydration, and de-stressing routines. It is absolutely vital during this time!
If you want to better prevent your vestibular migraine attacks, let down migraine attacks, and more, join us in Vestibular Group Fit for the most comprehensive group program for vestibular migraine!
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Long-COVID rehabilitation: The best Treatment for Long-COVID
We all were affected by the COVID-19 pandemic, and because of that we have all heard of Long-COVID, and hopefully, about Long COVID Rehabilitation. And, no matter what happened to you or around you during the pandemic, somethings has become more and more prevalent over the last few months is Long-COVID. Long-COVID is a hot topic, and I want to start off by saying one thing: You are NOT making it up. I have worked in chronic illness since I gratulated from Physical Therapy school and I understand the gaslighting in the medical system, especially the US medical system. BUT, I am here to tell you that you are making that up. Most people with the COVID-19 virus recover within 1 week, but that’s definitely not the case for everyone. According to UCLA health, one in three people with a COVID diagnosis will develop Long-COVID.
So, today let’s talk about it: what is Long COVID Rehabilitation?
Are you making up Long COVID?
You are not making it up! I want you to know that this is not in your head.
Your symptoms, whichever way you may be presenting, are very real. I have seen many providers who either ‘don’t believe you’ or ‘don’t believe Long-COVID would be so severe’. But, I am here to say that there are many different and debilitating symptoms!
The biggest issue we are having is that we don’t have enough research on covid and Long-COVID, so many provider just don’t know what to do about it at this point.
What are Long-COVID symptoms?
Long-COVID symptoms can be incredibly variable and truly span anywhere from fatigue to cardiovascular issues. Your symptoms can be cardiovascular, respiratory, general fatigue, fever, difficultly sleeping, and more. Because we just don’t know enough about Long-COVID right now, we can’t make an exact list. But, if you had COVID and now you’re experiencing symptoms you did not have before it could definitely be correlated with Long-COVID. Long COVID symptoms could last anywhere from a few weeks to years. COVID began in early 2020, and patients have been dealing with Long-COVID symptoms since that time. It’s difficult to say at this time if they last forever or not. However, it does seem like we are able to treat Long-COVID, though through LongCOVID rehabilitation and medication.
Long-COVID & Dizziness
Long-COVID is known to cause many different symptoms, as we discussed above. One of the overarching symptoms that we did not touch on above is dizziness. As a provider who treats dizziness and vertigo, I have been treating SO much Long-COVID. It started with just one patient who had dizziness related to COVID-19, but has been a very big influx of my caseload, especially for someone who treats Vestibular Migraine and PPPD usually.
Long-COVID Dizziness is thought to come from the virus infecting and inflaming your inner ear. Your inner ear controls balance and equilibrium, and spatial awareness. Without this organ functioning accurately, you will feel dizzy, light headed, and other related symptoms. Another Long-COVID dizziness diagnosis is POTS. POTS, or Postural Orthostatic Tachycardia Syndrome is an autonomic dysfunction. Autonomic dysfunction is your automatic systems in your body. Everything from digestion to heart rate and breathing are controlled by your autonomic system, because these are all involuntary. And, they’re REALLY important! Long-COVID rehabilitation, can help regardless of the type of dizziness you are experiencing after a Long-COVID diagnosis!
Long-COVID rehabilitation has had its difficulties in treatment, but it’s nothing that my patients and I haven’t been able to trouble shoot. Long-COVID is not one of those sicknesses that you get and then suddenly you just get 100% better again. There may be adaptation and compensations you have to make in your life, and your lifestyle may look a little bit different than it did pre-COVID. However, I do find that specific rehabiltation directed at each of your symptoms is incredibly effective in getting you back to at least some of your ‘normal.’
How do you treat Long-COVID?
Long-COVID is complex, and I like I said above, we just don’t know enough about it. But, we have seen that Long COVID rehabilitation is effective. Your symptoms can range anywhere from looks like POTS to seeming like a concussion. No matter what the symptoms, Long-COVID treatment is rehabilitation. Long-COVID rehabilitation providers are typically physical therapists and occupational therapists. There are also medical providers who have branched into this kind of medicine as well. There are a few studies that have shown to be somewhat effective in treatment with medication. At this time it is all preliminary information. UCLA and Stanford both have excellent West coast treatment centers. Additionally, there are a few others like in Kansas City, Germany, New York City, and more!
Treating Long-COVID from a medical standpoint and a rehabilitation standpoint is the best way to go about treatment overall. I recommend finding both a medical doctor and a physical or occupational therapist to help you rebuild strength, improve visual symptoms, reduce dizziness, and more.
Long-COVID Rehabilitation
Long-COVID rehabilitation will look like a few different kinds of physical therapy combined into one treatment plan.
At this point, there are not many experienced Long-COVID rehabilitation practitioners, none of have more than a year or so of experience. However, we all piecing together information the best that we can! If you are looking for a provider, I recommend calling around to physical therapist and occupational therapist offices and asking if they’ve had any experience working with Long-COVID rehabilitation patients. And, if there is not someone in your area, try and find someone who is at least willing to learn with you!
Currently, I am taking patients for Long-COVID rehabilitation in the following states via telehealth: Wyoming, Virginia, Maryland, California, New York, and New Jersey!
If you’d like to schedule an evaluation appointment to work with me, email me at [email protected] for more information!
Why do we get dizzy while driving?
Dizziness is a complex and frustrating symptom that often comes with driving. If you have ever been driving and had the overwhelming feeling that you need to pull over and stop, this might apply to you.
There are a few things that cause dizziness while driving. The first one is a binocular vision dysfunction like vertical heterophoria. This means your eyes are not aligned or they are struggling to work together as a team. I am not an eye specialist, but I can tell if eyes are having trouble teaming if you have difficulty with something like near-point convergence. This is the most common reason you will find on the internet for difficulty with dizziness while driving. However, there are other reasons you could be dizzy while driving, too.
Vestibular disorders and being dizzy while driving
People with vestibular disorders, like vestibular migraine, vestibular neuritis, meniere’s disease, and other frequently have difficulty with driving as well.
The dizziness while vestibular patients drive often presents similarly to those with binocular vision dysfunction. Most commonly, I see patients who describe their driving induced dizziness like they’re driving through a snow storm, like their visual system feels overwhelmed, or like they feel like the keep moving even when they’re stopped. This can cause severe anxiety associated with driving, a migraine attack while you’re in the car or when you get home, and more.
Another common complaint is getting feeling like you’re still moving even when you’ve stopped driving. If you pull into your driveway, or stop at a stop light and you feel like your body is still moving forward, you are absolutely not alone! I hear this constantly from my patients and clients. It’s a perception issue from your vestibular system and it can also be managed and treated.
If this sounds like you, there IS a solution. Vestibular Rehabilitation Therapy And Vestibular Group Fit™ are both excellent options for you.
Treating your driving related dizziness
Treating dizziness is best done with a holistic program that’s customized to you. You can customize it yourself, and you can use a qualified provider to help, as well! I recommend a combination of both.
The first step to treating driving related dizziness, is to determine WHY it’s happening. Many people have something called visual vertigo, and central peripheral visual integration issues. Visual vertigo is a common condition that comes from other vestibular disorders like vestibular neuritis, vestibular migraine, persistent postural perceptual dizziness, and other places. I often recommend finding the underlying condition, as well; but how to do that will be in another article.
After you figure out why it’s happening, which should be done with a qualified physical therapist, you can start retraining your brain and body to understand your surroundings.
Four steps to treating dizziness with driving
You and your physical therapist usually will take a few steps:
1. Watch a driving video taking up 90% of your visual field and reduce the anxiety that comes with driving.
2. Use Virtual Reality Goggles to make you feel as though your driving.
3. Slowly reintroduce you to driving in safe environments (empty parking lot, neighborhood, back roads, main roads)
4. Increase distance, speed, and more using your coping skills and managing your dizziness accurately.
Treat your dizziness with driving from home
Your dizziness can also be treated on your own if you’re the kind of person who thinks group coaching is a great fit for you! In Vestibular Group Fit™ we treat dizziness while driving in the Driving Module. This can be accessed only as a member of Vestibular Group Fit™. We go through why you may be dizzy with driving, exercises you can do while you’re driving, and how to return to driving safely. Click below to take the 3 Steps to Control your Dizziness & Vertigo MasterClass and start your healing journey!
How to travel with dizziness
Living with a vestibular disorder is frustrating and can make you feel like you can’t do activities that once came naturally and easily to you. Traveling may be something that once came easily to you that now seems close to impossible. Busy visual environments, patterned carpets (hello, PDX), the anxiety about having a flare, and more can make it more anxiety provoking than fun.
However, I want you to know that it’s absolutely possible for you to travel with a vestibular disorder, you just may need to make a few adjustments!
10 tips to planning travel with a vestibular disorder
Just like with most things in the vestibular world, planning is going to be your friend here. Ask yourself a few questions before you decide what type of travel you’re going to do, and where you may want to go.
- Am I going somewhere new or familiar?
- Is my destination vestibular-friendly?
- Am I traveling alone or with a trusted person?
- What do I need to talk to my doctor about?
- What activities am I going to do when I get there?
- How can my vestibular physical therapist help me prepare for this trip?
- What can I pack to help me manage my symptoms?
- What’s my travel plan when I arrive?
- What mode of transportation am I taking?
- Does my diagnosis prevent my from traveling entirely?
When you have the answer to those questions, you can then consider how you can best support yourself throughout your trip. For instance, if you’re going somewhere like the Coast of California, you won’t have to really consider how the weather may affect you, but if you’re traveling to the East Coast then you may want to prepare to track the weather and treat accordingly.
Does my vestibular diagnosis prevent me from traveling?
In short, the answer to this question is no. However, there are a few factors to consider here. Ears ‘pop’ when you go up and down in elevation, whether it’s a fast elevator or a flight. If elevation changes bother you, then you should prepare for that. Otherwise something like driving or train travel is usually safe.
Safe to travel, in this case, means that you won’t do any extra harm to your vestibular disorder. It does not mean you won’t have a flare. This is why having the answer to the questions above and preparing accordingly is so important.
One last thing to note is 2 vestibular diagnoses that should be more wary of flight. The first is if you are undergoing surgery for superior canal dehiscence syndrome. In that case, you will want to wait the appropriate amount of time post-operatively before flying. Talk to your surgical team if you need to travel right after. The other diagnosis to be wary of it Perilymph Fistula. This diagnosis needs to be considered because sometimes pressure changes can indeed make the condition worse. As always, talk to your doctor.
Rapid elevation changes and your vestibular disorder
Traveling, whether it’s driving, flying, or otherwise, may have rapid elevation changes, this make your ear ‘pop’ and can cause symptoms or cause you to be uncomfortable. And, of course, that’s no fun, especially on vacation. So, how can we mitigate the affects of elevation changes on your vestibular disorder?
- Chew gum or eat while taking off and landing in an airplane
- Wear Ear Planes
- Avoid really high floors of a hotel with a fast elevator
- Avoid SCUBA diving and deep water diving
- Ask your doctor about taking a decongestant for the travel itself, which can help with your ear pressure
- Avoid unpressurized planes (hopper planes)
Planning travel around the weather and your vestibular disorder
Weather can be a really big factor for having attacks with a vestibular disorder. And in a world where we are doing everything in our power to avoid an attack, Mother Nature is not always in your favor. So, what can you do about it?
Track the weather with Accuweather:
- Google “Accuweather [insert city] migraine forecast”
- This tracks barometric changes and barometric pressure overall so you can track the weather and use your preventative treatment accordingly.
Consider where you’re headed. If you have a choice, maybe try somewhere that has fewer pressure fluctuations in general, and maybe somewhere with a temperate climate. This way you can enjoy the weather and your vacation without worrying about the weather. If you don’t have a choice, just pack according to the weather and what you’ll need – and I’m not just talking about clothes. You will also need to consider medications, preventive and rescue treatments, and more for your trip. And that’s okay, nothing a little extra planning can’t help!
Packing for travel with a vestibular disorder
So I know many people who overpack clothes, but not enough of us overpack essentials. Essentials for your day yo day life is what I am talking about here.
Medications
- Count out enough medications for the number of days you’re going, plus 2-3 extra days incase something happens
- Keep the medications, supplements, stimulation devices (like Cefaly and GammaCore, etc.) in your personal item so it’s easily accessible throughout the flight
- If you’re going to be changing time zones, be sure to ask your doctor/healthcare team about what
Nutrition & Hydration
Travel is really dehydrating in general. Bre sure you’re packing food and water with you on the place. You can’t bring liquids into the airport with you, so bring a water bottle with you instead and then fill it up when you get through TSA/security. If you’re driving, try and refill the bottle throughout the day, or bring more than one with you so you have enough to last you the whole trip . It’s really important that packing food that we are packing nutritious food. Road trips make us think (myself included) that we can eat junk and it will be fine. I’m not sure why we do this, but we do. So, instead of waiting for the gas station to stock up, pack food ahead of time and use the gas station for a treat if you want, instead of the other way around.
Tips for car travel
- Do a workout in the morning before the drive
- Get a good nights sleep before
- Eat a solid meal for breakfast before leaving
- Take a break every few hours to take a short walk
- Avoid high traffic hours
- Pack snacks and keep your blood sugar regulated
- Bring water and sip throughout the day
- Pack ginger chews for nausea
- Keep the windows cracked or the A/C on for cool air
- Stare at the horizon to keep your VOR steady
- Try to be the driver, if you’re safe to do so, rather than the passenger
Tips for plane travel
- Chew gum on the way up and down (or pop your ears otherwise)
- Walk while you’re in an airport for exercise and grounding
- Workout in the morning before leaving
- Get an excellent nights rest the night before
- Try to sleep on the plane, and bring a neck pillow
- Use grounding throughout the flight
- Pack a water bottle, I like this one because it has a straw which makes drinking in motion easier. Sip every 10-20 minutes, instead of chugging water
- Try and pick a seat over the planes wings so it’s not as turbulent
- Take extra magnesium with you if that’s a part of your treatment plan
- When you arrive, take a short walk to bring yourself back to baseline
- Try to arrive at night or in the evening so you can eat and head to bed – this will also help with the jetlag
How to manage visual stimuli with travel
Vision can feel like the issue when it comes to vestibular disorders, this is because your ears and your eyes are so connected.
So, instead of being miserable on your trip in stimulating visual environments, let’s talk about what you can do to help!
- Before your trip, ask your physical therapist to help you with visual vertigo exercises
- Join Vestibular Group Fit and use the Visual Vertigo Module to help you acclimate
- Wear tinted sunglasses when you’re outside (never inside) to help with light sensitivity
- Wear Avulux Glasses when you’re inside (and/or outside) to help with light sensitivity (use the code VERTIGODOC for a $25 discount)
Don’t Forget!!
As always, remind yourself that feeling dizzy, off, and generally uncomfortable after a long day of travel is actually really normal. Do the best you can to remind your body that you are safe, secure, and in a fun new place! Focus on having fun and less on what might happen during your trip.
Movement and exercise are two words that can be really triggering for people with chronic illnesses.
You may have heard someone say to you “just exercise, you’ll feel better,” but when we take that advice from our doctors the opposite effect might happen. More often than not, picking up a new exercise routine can actually make you feel worse if your symptoms and current state of chronic illness is not considered first and foremost.
Exercise can 1000% be used to your advantage, and you can absolutely reduce your sensitivity to movement, reduce the number of attacks you have, raise your threshold, and improve your quality of life through movement. But, not if you don’t do it with very specific intentions.
There are workouts designed for new moms, chronic pain, Multiple Sclerosis, and more. So, why not workouts for vestibular disorders, too?
That’s where Vestibular Group Fit comes in!
Vestibular Group Fit is the best workout for those with vestibular migraine and other vestibular conditions! It’s not feasible or logical for your healthcare provider to tell you to just ‘start exercising’ or for you to begin right after you finish vestibular rehabilitation therapy. It’s truly unfair to try and send you on your own. That’s why Vestibular Group Fit exists, to help you get back to a place where you can move your body comfortably, and not trigger an attack.
Vestibular Group Fit is a workout for those with vestibular disorders. Relearning how to do functional activities is one thing, but getting back to workout classes is an entirely different beast. There are so many triggers at the gym and regular workout classes! Fluorescent lighting, loud music, moving people, big weights, and more. All of these can be triggers that are incredibly irritating on your system. But, it does not have to be this way.
You can exercise and move in a way that promotes physical health, mental health, and vestibular health. This will ultimately reduce your dizziness, improve your confidence, help you get back to driving and the grocery store, and more. You can raise your threshold to migraine attacks.
Raising your threshold comes from the threshold theory of migraine. This theory states there are are many different factors contributing to your migraine attacks, and when they all pile up you hit your threshold and have an attack. But, if you raise that threshold (which takes time and effort but is very doable) you will have fewer attacks and a higher quality of life.
Raising your threshold takes consistency over time. It takes movement, education and knowledge, and support. Vestibular Group Fit offers all of these things, it’s so much more than just a workout.
The Support group is filled with like-minded individuals who are on a journey toward healing through movement, mindset, and knowledge. These three things are some of the pillars of Vestibular Group Fit. And, when they’re consistently upheld, you will see the results you’re looking for.
Below is a link to learn more about Vestibular Group Fit, how it works, and how other people have been successful in their journeys through movement.
The vestibular system is incredibly complex and in a perfect world it tells you, with impeccable accuracy, where you are in relationship to the rest of the world. It acts as a gyroscope – this means it measures angular velocity and maintains a perfect upright posture (plus, your vestibular system also measures linear velocity). It’s a pretty cool system, but when something goes wrong you could have a big problem.
Here’s what we are NOT focusing on today:
If you have a vestibular disorder you know that being upright can be a challenge, but why is it that a position of comfort, like lying down, is so problematic? I am not talking about Benign Paroxysmal Positional Vertigo (BPPV). BPPV is a mechanical issue where otoconia (ear crystals) fall from the otolith organs into the semicircular canals – this causes true room-spinning vertigo lasting from 15-60s with position changes. You can read more about it here. I also want to mention that I am not talking about MdDS. MdDS is a different condition secondary from disembarking from passive movement (like a bus, train, car, or train) and the symptoms does go away for weeks to months at a time. The treatment for that is the Dai Protocol and that’s NOT what we are talking about today. But you can read about it here.
Here’s what we are focusing on today:
The other kind of dizziness when you’re laying down, the kind where you feel like you’re on a boat when you’re in bed, happens for a few others reasons:
- Your vestibular system doesn’t understand what position you’re in
- Poor integration between your 3 balance systems
- Your vestibular system is fatigued
- Your bed is an uneven surface
- You have anxiety about ‘causing’ BPPV (rest assured, you can’t trigger it by laying down)
Let’s Break These Down:
Your Vestibular System Doesn’t Understand what Position you’re In
Your vestibular system’s full time job is to determine where you are in space. It helps keep you upright (the Vestibulospinal Reflex), it detects head motion and moves your eyes accordingly (Vestibuloocular Reflex), it determines head position on the neck & neck movement (Vestibulocollic Reflex), and more! If your body doesn’t know exactly where you are in space, it’s trying to find the answer. The chronic unknowing-ness, along with anxiety that you could be doing something wrong tends to ramp up the feeling of rocking when you’re laying in bed. I can’t say its completely abnormal. because it’s happened to me a few times before and it is incredibly frustrating.
Your vestibular system has a lot of responsibility, but it also relies on other systems and programs in your body to help you interpret what’s going on in your body. This brings us to our next topic.
Poor Integration Between Your 3 Balance Systems
You have three balance systems in your body. Proprioception, the ability for you to feel your surroundings, vision, your ability see your surroundings, and vestibular, your ability to track acceleration and motion. All three of these systems need to integrate together in order for you to know where you are in space and decrease the rocking and swaying sensations. When these three systems don’t integrate, the rocking and swaying can start. Reintegrating them through movement, behavioral change, and vestibular rehabilitation, and vestibular education is the solution here.
Your Vestibular System is Fatigued
An injured vestibular system is working twice as hard and not getting 100% function. Working double time is never easy, especially if your vestibular system is just trying to keep you upright all day. Your body’s #1 function is to protect your brain, and to keep you from hitting your head. Doing anything else besides keeping you upright is hard for your brain and vestibular system. this causes vestibular fatigue, brain fog, and other irritating symptoms. This causes rocking and swaying at the end of the day because that system is just so exhausted it can’t function well anymore.
Your Bed is an Uneven Surface
Your bed will never not be uneven. You are going to have a soft bed – and no, buying a firmer mattress is not going to help. Your proprioception knows that your bed is uneven, and that can be irritating for the system as a whole. If your proprioception system isn’t sending a system that although you’re on an uneven surface you are still, your vestibular system becomes confused, perceives the wrong information, and then makes you feel like you’re moving.
You have anxiety about ‘causing’ BPPV
Having a history of BPPV can be scary, and it can be the reason you don’t lay down flat. The first thing that I want to make clear is that you are not going to ’cause’ BPPV by laying down. I know it’s scary, but if you get a BPPV attack it’s because the otoconia are already displaced and then you laid down afterward. However avoidance and sleeping at an upright position will cause dizziness over time, can set
So What if you Want to Fix the Swaying?
All the information you need is in the “Laying Flat” module of Vestibular Group Fit. By being a Vestibular Group Fit member you will learn all the education and exercises I teach to my Vestibular Rehabilitation Patients.
Click here to join us!
Vestibular disorders, especially Vestibular Migraine, can cause neck pain and cervicogenic dizziness. However, thankfully, these are both manageable with vestibular physical therapy and cervical (neck) physical therapy. The neck is a complex group of muscles, bones, joints, and other soft tissues that can easily make you feel ‘off’ or out of place.
Luckily, that feeling does not have to last forever. Cervicogenic dizziness and other neck dysfunctions are very treatable. One of my favorite ways to manage cervical issues is stretching. Here are my twoi favorite stretches:
Pectoral stretch
Your pec muscles are located in the front of your chest. You have 2 on each side, the pec major, and the pec minor. The pec major is larger and lays on top of the pec minor. To stretch them both, you need to perform 2 different stretches for best results. In this video we see three stretches.The first two stretch the pec major, and the last stretches the pec minor. The further up the doorway you place your hands, the more you’ll get into the pec minor.
Trapezius stretch
If the back of your neck is bothering you, it can come from your chest, but another great stretch is a trapezius stretch, which will help stretch the back of your neck. The back of your neck is made up of quite a few muscles, but the biggest one, which tends to feel knotty, is the trapezius muscle. Here’s my favorite way to stretch the back of my neck. Watch the video, and if you want a second stretch for a similar movement, don’t twist your head!
What else can help neck pain?
Other than stretching, many things can help with neck pain. General exercise, improving your posture, and taking breaks from sitting.
General Exercise?
Exercise is good for us. Whether or not we’d like to admit it, we know that it’s something we should participate in regularly. There are a few exceptions, but it’s statistically unlikely that you’re in that group of people. If exercise makes you dizzy, or you’re worried that it could make you dizzy, Vestibular Group Fit is the answer to your issue. Vestibular Group Fit is the all-in-one, holistic solution to strengthening your vestibular system, helping you to move, and more! This helps you get rid of your neck pain through movement, and will help you prevent dizziness attacks in the future!
Improving your Posture
Your posture is just as important as your mom said it would be. If you ever thought that you may be having dizziness BECAUSE of your neck, your posture could be playing a roll. Your posture is in charge of where your head is – it’s all about your neck. If you neck is giving your brain a ‘bad’ signal about where your head is in space, it gets confused and send a dizziness signal. But, it can be treated with Cervical Physical Therapy and Vestibular Group Fit!
Taking Breaks from Sitting
Sitting for too long can be harmful to our posture, and if we remember from above, our posture can make us feel dizzy if it’s poor. In a world where we all work from home, it can be easy to get into the routine of sitting at your desk and not leaving until you finish work, except maybe a trip to the kitchen or two (I am guilty of this myself). Instead, it’s vital to take sitting breaks. Every 45-60 minutes stand up, walk to get a glass of water (yay, hydration!), grab a snack, or just take a lap around the house. It doesn’t matter what you do, but set a timer and make it happen! It will help your neck, back, and vestibular system!
Your vestibular system is a vitally important structure located in your inner ear. It is responsible for balance, equilibrium, spatial awareness, and more. It is connected to the cochlea and depends on fluid, nerves, and ear crystals (otoconia) for function. Vestibular hypofunction is a common dysfunction and means that your vestibular system is functioning ‘less’ than it should be (hypo=less). A unilateral vestibular hypofunction is more common than bilateral, and that’s why you find so much more information on it on Google.
Unilateral vestibular hypofunction means that one of your vestibular systems is working suboptimally. Bilateral vestibular hypofunction means both of your vestibular systems are working suboptimally. In rehabilitating a unilateral dysfunction, the opposite side can be used to help you compensate for the other side. However, with bilateral vestibular dysfunction, both sides have some sort of dysfunction, and cannot be used to compensate, adapt, and/or habituate.
What Causes Bilateral Vestibular Hypofunction?
Bilateral vestibular hypofunction can come from many pathologies. Those with vestibular migraine, bilateral Meniere’s disease, history of meningitis, CANVAS, superficial siderosis, and others can cause bilateral vestibular hypofunction. Regardless of the causation, once you have bilateral loss it’s important to understand what it is, how to manage it, and how to take care of the rest of your health.
Symptoms of Bilateral Vestibular Hypofunction
- imbalance
- dizziness
- instability
- disequilibrium
- oscillopsia/gaze instability
- visual vertigo
- brain fog
- fatigue
- other cognitive deficits
If the bilateral vestibular hypofunction is a result of another neurological disease, you may also be experiencing alternative symptoms secondary to the diagnosis.
Bilateral Vestibular Hypofunction Management
Managing bilateral vestibular hypofunction is about much more than medication, in fact, in the chronic phases of bilateral vestibular hypofunction it’s recommended not to use medication, but o use vestibular rehabilitation therapy and exercise to promote healing (1). In a randomized control trial, those who underwent vestibular rehabilitation treatment had significantly better outcomes in function and balance than those who had no treatment or only used medications. This is likely because the mediations typically prescribed are vestibular suppressants and anti-emetics. Vestibular suppressants will actually hinder your system’s function further, and anti-emetics are only to treat the symptoms so nausea and vomiting associated with vestibular dysfunction.
Managing bilateral vesitbular hypofunction requires strengthening your physical body, improving the use of your proprioception, maintaining eye health, and continuing your general health. You have three balance systems, and one (your vestibular system) is not functioning at 100%, but strengthening the other two (vision and proprioception) will help you maintain the best balance possible. Additionally, taking care of your physical health, preventing other morbidities like diabetes or cardiovascular dysfunction, and staying as fit as you are able will help you keep your balance and equilibrium as much as possible.
What is Compensatiton
With a permanent injury to any system, the body uses another system or external resource (like a cane) to make up for the loss of the damaged system. In a unilateral vestibular hypofunction, the adaptation of the brain and opposite vestibular system returns your equilibrium to a new normal by rewiring brain pathways (through neuroplasticity). With bilateral vestibular hypofunction, since we cannot use the opposite system to adapt and compensate, you may need to employ other tactics.
For bilateral vestibular hypofunction, external compensation tactics are frequently a good idea. I recommend the following:
- A cane or walker for uneven or difficult environments
- Flat shoes with good match support so you are able to feel the floor (avoid shoes with high platforms or a heel)
- Wear migraine classes if you are light-sensitive
- Wear earplugs if you are sound sensitive
Bilateral Vestibular Hypofunction Requires…
A lot of attention to yourself and your balance systems. I know that this is true for all vestibular dysfunctions, but especially for Bilateral Vestibular Hypofunction. What questions do you have about BVH I can help you answer? Comment below, or shoot me an email!
Vestibular Group Fit has Premium Content dedicated to understanding Bilateral Vestibular Hypofunction. Strengthening your legs and body is one of the best things you can do to improve function and feel less wobbly with Bilateral Vestibular Hypofunction.
Sources:
(1) Horak FB, Jones-Rycewicz C, Black FO, Shumway-Cook A. Effects of vestibular rehabilitation on dizziness and imbalance. Otolaryngol Head Neck Surg. 1992;106(2):175-180. PMID:1738550
Treating a vestibular disorder can feel impossible – but here’s the good news, it is not impossible to treat a vestibular disorder! I have to say this first: do not give up hope when trying to treat your vestibular disorder. Dizziness can lead to infinite doctors appointments, feelings of frustration, and thinking that you might throw in the towel.
Vestibular Disorder Treatment
Vestibular Disorder treatment does require hard work and multiple doctors who know what they’re talking about. If you haven’t found one yet, please check VEDA (or here if you’re in the UK). Treatment is multimodal, meaning that you need multiple healthcare providers to do their jobs together as a team to help you- this is not a single-doctor-only diagnosis. It’s essential that your whole team works together, talks you each other, and is aware of your plan and changes to that plan.
Top Three Tips for Dizziness Treatment
Track your triggers (in the short term)
Tracking your triggers means that you should write down what you eat, the weather, your sleep, and your symptoms daily. I recommend doing this for four weeks. For some, this becomes a stress-inducing habit, and if that is the case for you, please do not do this and enlist the help of a professional!
Find an Excellent Healthcare Team
Finding healthcare providers that treat vestibular disorders can be difficult, but finding a person to listen to you and help you differentiate the diagnoses is endlessly helpful. IF you can’t find a provider on the VEDA link above, find a neurotologist to help you in your area or via telehealth. Most of the exam when diagnosing dizziness is subjective. If you’ve been to multiple doctors and already had standard testing (MRI, CT, etc.), you may be able to go to an out-of-state doctor via telehealth. Another important team member is a vestibular physical therapist. PTs are the ones who are going to help you get your life – return to function is through PT!
Be Consistent about your Treatment
Consistency is key in any major life change, especially with chronic illnesses. There are no quick fixes. Finding things that work for you can be a long journey, but it is helpful in the long run. If you can consistently change a few things here and there, it is often more valuable than making one significant change. Again, treating vestibular disorders is a holistic journey. You will likely trial and error many treatment options before you find out what works for you. Keep track of what you have tried (write it down, I love to do this in an excellent journal), keep a record of your symptoms and your flare-ups, and also track what did not work. Medications, diets, and more have likely been thrown at you, and trying many routes isn’t a bad idea.
Finding your Beginning
Everyone begins at their beginning – we don’t have the same starting point as anyone else. It’s important to remember that even when we ask others who have been where we are now for help, they had their journey and beginning. Be careful not to get caught up in someone else’s beginning – find yours and stick to what works for you.
Stay the Course
Vestibular disorder treatment is a long and often grueling journey. Finding something that will work for you can sometimes be daunting, but there truly are always options. You can always fire your doctor if they don’t listen to you. you are welcome to try something new if your think it will work for you. Do not give up – keep on pushing through, even on the hard days where it feels impossible.
The holidays can be tough, and so can gifting! I don’t know about you, but in my family, we ask for exactly what we want so there’s no guesswork and everyone ends up happy campers. However, figuring out what would be a useful thing to receive can be difficult. So, I’ve put together this guide. Send it to your loved ones, or gift something to yourself! These ideas help decrease your trigger load and will help improve your quality of life with a vestibular disorder!
Avulux Glasses
I recently talked to the people at Avulux, and I am officially obsessed. They are the only brand of migraine glasses that has real third-party research backing them up! They filter out many wavelengths of light, not just blue light, that can be irritating for migraine and let through the green light that is soothing for migraine. They have research to show that wearing these glasses within an hour of a migraine can actually decrease the impact of your migraine and dull the pain without an abortive medication. They have options for prescription and non-prescription glasses, which is also a game-changer. Here’s a video on how it works. Code vertigodoc will get you $25 off your order!
Migraine Shields for Light Sensitivity
Migraine Shields are made by a vestibular migraine warrior for vestibular migraine warriors. They block the spectrum of blue light that people with migraine are sensitive to while letting some forms of blue light through – so things like sunlight and natural forms of light can get through, which is important for your circadian rhythm! You can use code vertigodoc20 for 20% off of your order!
Vitamins for Vestibular Dysfunction
Taking daily vitamins daily is essentially important for a vestibular disorder. My favorite vitamin company for people with vestibular dysfunction is Pure Encapsulations. They have very few additives and people do very well with them. However, if those are out of your price range, and you can tolerate Soybean oil (present in some vitamins), I’d recommend Nature Made Vitamins. If you or your loved one is in need of vitamins for Vestibular Migraine, that article can be found linked here. Vitamins and supplements are the first treatment for vestibular dysfunction very frequently, and research shows that they can really help decrease the symptoms – so it’s always worth a shot! But be sure to check in with your doctor first.
If you want to gift vitamins or supplements to a friend or family member, try subscribing to the vitamin on Amazon, that way you can get them a whole yea of vitamins and really take the stress out of ordering them monthly!
Vestibular Group Fit Subscription
Vestibular Group Fit is the only exercise and movement program based on your vestibular system. It intends to improve your physical strength, cardiovascular health, vestibular strength. VGF is the ONLY program created with your needs in mind. It accounts for dizziness, fitness levels, and difficult days where movement may feel impossible. It also includes premium content such as how to treat visual vertigo, navigating social situations, and more! You have the opportunity for 6 workouts per week, 3 of which are live classes. Come celebrate your body and movement with us!
The Dizzy Cook Cookbook
Alicia Wolf, the author of the Dizzy Cookbook, the absolute best when it comes to all things heal-your-headache diet. So many people with Vestibular Migraine respond incredibly well to altering their dietary needs. This book has more than the recipes you find on her blog, and she also has cute aprons and other products available! Check them out here.
Loops for Sound Sensitivity
If you, or your loved one, have sound sensitivity with migraine (or between attacks) Loops earplugs are your friends! They are specifically designed to decrease ambient noise, while letting you hear all other noises around you. You’ll be able to hear conversations around you, but the crowd noise will be blocked out – this is ideal for people who have hearing loss, hyperacusis, or difficulty paying attention to what their conversation partner is saying. Plus, they come in many colors, like silver, gold, black, roses gold, maroon, and more. And, the ear bud can be changed to meet the size of your ear, which is awesome!
Cefaly Device for Vestibular Migraine
The Cefaly device is very helpful for 
neuromodulation of migraine attacks. This has a preventative mode and an attack mode. You can read more about the Cefaly device, and other neuro-modulation devices here. The only one you can purchase over the counter is the Cefaly, and it’s a great one to try as they have a 90 day return period!
Allay Lamp
The Allay lamp is based on research that a specific wave of green light will help to decrease head pain and calm your brain during and between migraine attacks. If you are light-sensitive but need to get work done, the Allay Lamp is for you or your loved one! It emits a specific kind of green light that is calming – you can still get your work done without feeling the immense pain of bright lights during a migraine attack.
Norb Lightbulb
Norb lightbulbs are based on the same light technology that Allay Lamps and Avulux glasses use – green light is so calming! This light bulb can be placed into any lamp or light that holds a bulb. Itt will make the entire room green. They also have new research to show it helps with sleep!
