Magnesium is an incredibly important supplement in our bodies, especially if we have migraine. Many studies have found that taking daily magnesium can help reduce migraine attack frequency and intensity. Typically the dose is 400-500mg/day for prevention, and then more for an acute dose if you’re trying to stave off an attack.
Magnesium oxide is the most common form of magnesium found in most stores, and if you pick up most drug store magnesium, it will likely be oxide. This is an affordable option and it’s in Class A of supplements, meaning it’s safe during pregnancy.
Magnesium glycinate is the slightly less common form of magnesium, however its still easily accessible and does not cause the stomach upset that oxide does!
AKA CogniMag is something that many in the Vestibular Migraine community swear by for grain fog! IT’s a slightly different make up of magnesium and helps with improving cognition.
Magnesium in Foods
Many common foods are high in magnesium, and if you’d rather just try to eat enough throughout your day, you are welcome to try. The most common foods with high magnesium are beans/legumes, nuts and seeds, fiber-rich whole grains, dairy products, and many leafy greens. Although it’s entirely possible to get enough magnesium in your diet this way, it’s unlikely enough for a person with vestibular migraine, as a person with VM is typically low in magnesium, even if they eat a well-rounded diet.
Magnesium spray is a topical form of magnesium that can help get magnesium into your bloodstream, without ingesting it orally. Because so many people are sensitive to magnesium in their gastrointestinal system, it’s not always an option to take it orally, even if you want to. A great place to start, other than your diet, are topical options! 4 sprays of this, on your skin, provides 66mg of magnesium! Although it’s a ways to get up to 400, it’s an excellent place to start!
Magnesium lotion, similarly to spray, is another topical option for you. This way, you won’t have gastrointestinal upset, but will still be able to increase the amount of magnesium your bloodstream absorbs. Additionally, it is a great way to practice self-massage on your neck. Take some of this cream, dab it on your neck, and rub your neck and shoulders for a neck-pain-relieving massage.
Sometimes when you are having a high pain migraine day, there’s nothing better than a warm bath. Pop this magnesium bath and foot soak in a bath of warm water and relax!
The last option for non-oral magnesium is a roller. You can roll this anywhere on your body, it can sometimes help with sleep when put on your temples, or head pain relief!
Dizziness, vertigo, and anxiety create a vicious cycle. The short answer is yes; vertigo can be caused by stress. However, typically dizziness is caused by stress, not true vertigo. Even if you do not consider yourself to be an anxious or stressed person, there is a high likelihood that you will experience stress and/or anxiety after getting vestibular symptoms. This is because of the close relationship between the stress and anxiety center and the vestibular system.
What is Vertigo?
Vertigo is the incorrect perception that you or the room around you is moving or spinning. This can be in the form of room-spinning vertigo, typically from Benign Paroxysmal Positional Vertigo, or BPPV, or from Meniere’s Disease or Vestibular Migraine. Vertigo is not all dizziness, however many of us incorrectly name our sensations vertigo even when they are ‘dizzy’ by definition. Dizziness accounts for: lightheadedness, heavy-headedness, bouncy, floaty, and other terminologies. It’s important to distinguish the two different sensations as it can help your doctor or other healthcare provider determine an accurate diagnosis. Stress can be a factor causing vertigo and dizziness alike.
What Regulates Anxiety and Dizziness?
The Limbic system is made up of the amygdala, hippocampus, and hypothalamus; it regulates emotion and processes memory (1). Additionally, it is responsible for fear & aggression, and joy & excitement. The limbic system is tightly bound to the vestibular system through many synapses, so when you begin to get dizzy, you may start to feel stressed or anxious simultaneously. Research has shown that when pigs are given a lesion in their vestibular systems, they immediately begin to produce the stress hormone cortisol (2). Additionally, in a study done on people, when caloric testing is performed (which makes you dizzy), levels of stress hormones increased significantly, and those who are prone to motion sickness had already-elevated stress hormone levels (2). Our brains are not structured to endure lengthy durations of trauma or stress, which causes the link between anxiety and dizziness.
Neurons that fire together, wire together. – Donald Hebb
We have many neurons firing in our brains and nervous system; this is how our body functions. Our brains are plastic – meaning that our brains can learn and change constantly, as much as we need them, to suit our current needs. I’m going to repeat it: neurons that fire together, wire together. This phrase was coined by neuropsychologist Donald Hebb and describes how neuronal pathways form through reinforcement. If you’ve ever tried to learn a new skill, whether it was driving, playing violin, typing, or doing schoolwork, you likely noticed that the more you did something, the better you became at your new skill. The same rule goes for anything. If you find you are feeling dizzy and then immediately becoming anxious, or stressful thoughts begin to enter your head, it can make the dizziness increase exponentially. Neurons that fire for dizziness and then immediately cause anxiety wire together. This creates the dizzy-anxious-dizzy cycle.
Donald Hebb goes further into talking about why we should practice gratitude, which I think is vital for those with vestibular disorders. Wiring dizzy sensations with gratitude, or other positive sensations, can actually decrease dizziness overall.
How to Break the Dizzy-Anxious-Dizzy Cycle?
Dizziness can absolutely be caused by stress and, as we discussed above, if a stressed or anxious neuron is fired, over and over, at the same time as a dizzy neuron, the two will wire together. Breaking the cycle can be difficult, especially if it’s rooted deep within your brain from years of repetition. The gold standard for dizziness related to anxiety is vestibular rehabilitation therapy, cognitive-behavioral or acceptance and commitment therapy, and medical care.
Vestibular Rehabilitation Therapy and Anxiety
After a vestibular diagnosis, you may feel like you never want to move again – the less you move, the less dizzy you feel, right? Unfortunately, that line of thinking is false and disproven. However, that also means you are able to move freely and as much as possible! If movement feels scary to you, like you might fall over, or trigger a dizzy episode, vestibular rehabilitation therapy is right for you! Vestibular rehabilitation therapy provides a safe environment to help you return to movement without triggering severe symptoms. Being able to move with a vestibular physical therapist to perform functional movements shows your brain that you are safe, secure, and calm. This will remind your brain that moving does not have to make you feel dizzy, and regardless of your diagnosis, it will slowly recalibrate your brain to receive vestibular inputs correctly
We think about going to therapy for typical stress, depression, and anxiety. However, we don’t consider going to therapy for vestibular needs nearly enough. Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) are both excellent kinds of therapy that work to decrease dizziness and improve function. Research shows that patients with chronic dizziness, especially PPPD, make improvements with therapy, especially when combined with vestibular rehabilitation therapy (3). Although there is not a randomized control trial at this time, the pilot study showed great results.
My favorite resource for all things dizziness-related therapy is Dr. Emily Kolstenik. She has two courses, Breaking the Dizzy-Anxious-Dizzy cycle, and Committing to Balance. One is a mini-version of the other, and they are both excellent resources for you if you’re looking to learn more about the vestibular system, decrease anxiety, improve your self-awareness in a healthy way, and decrease your dizziness symptoms.
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(2) Saman, Y., Bamiou, D., Gleeson, M., & Dutia, M. B. (1AD, January 1). Interactions between stress and vestibular compensation – A Review. Frontiers in Neurology. Retrieved October 5, 2021, from https://www.frontiersin.org/articles/10.3389/fneur.2012.00116/full#h3.
(3) Kuwabara, J., Kondo, M., Kabaya, K., Watanabe, W., Shiraishi, N., Sakai, M., Toshishige, Y., Ino, K., Nakayama, M., Iwasaki, S., & Akechi, T (2020, June 11). Acceptance and commitment therapy combined with vestibular rehabilitation for persistent postural-perceptual dizziness: A pilot study. Science Direct. Retrieved October 5, 2021, from https://www.sciencedirect.com/science/article/abs/pii/S0196070920303033?via%3Dihub.
Vestibular Migraine, as I’m sure you know by now, can be incredibly challenging to manage. Between weather changes, hormone changes, food triggers, and decreasing your caffeine intake, ‘a challenge’ doesn’t even begin to describe it. There’s a new study that I wanted to bring your attention towards, Dietary alteration of n-3 and n-6 fatty acids for headache reduction in adults with migraine: randomized controlled trial.
This article is interesting because instead of taking another thing out of your diet, it talks about something you can and should eat more of – finally!
What Food Group is Great for Vestibular Migraine?
This new study from the British Medical Journal shows that increasing Omega-3 Fatty acids, and without decreasing Omega-6’s can help decrease migraine pain, days, attacks, and other migraine-related symptoms.
The research shows that altering Omega-63s without changing Omega-6’s can decrease pain severity and frequency of attacks. However, the research did not find that there was a significant difference in quality of life.
What’s the Science between Omega-3’s and (Vestibular) Migraine?
Vestibular Migraine occurs due to a complex cascade of events that begins in the brain stem and trigeminal nerve, impacts the trigeminocervical complex, and then impacts the vestibular system. This cascade of events is what causes both pain (trigeminal nerve) and dizziness (vestibular nerve) in those with vestibular migraine. Omega-3’s are protective against that response.
As human beings, we are great at many things, however, synthesizing our own Omega-3 and 6’s is not one of them. Therefore, we can alter the number of fatty acids we have at any given time with our diet and/or supplements. And, it just so happens that these fatty acids are essential to the migraine cascade – in fact, they have a big role in pain regulation.
The nerve endings of the trigeminal nerve (the one that causes pain in migraine) are regulated by these same fatty acids, called lipid mediators. These mediators and together known as oxylipin receptors, and they’re enriched at the end of the trigeminal nerves. They regular sensitization and the release of the headache-related neuropeptide calcitonin gene-related peptide (1). This fact implies that there is a link between omega-6 & 3 fatty acids and headache etiology.
The oxylipins that come from Omega-6’s have been found to “sensitize the trigeminal nerve endings, and evoke behavioral pain responses;” this means Omega-6’s can increase pain severity and migraine frequency (1). However, the oxylipins that are derived from Omega-3’s are found to have antinociceptive properties, meaning that they reduce pain (1).
Where do I Find Omega-6’s, and Should they be Avoided?
Omega-6, the kind of fatty acid that is found mostly in the typical American diet, in fact, there is research to show that most people who eat a Western diet eat significantly more Omega-6s than Omega-3’s. Omega-6’s do play a role in our body’s function, so you should not completely get rid of this kind of fat. However, because we eat so much Omega-6, and want to try to fit in more Omega-3, it’s important to know where they come from.
Vegetable oils
Soybeans
Corn/corn oil
Eggs
Some meat and fish
Where Do I Find Omega-3’s?
Omega 3’s are to kind of fatty acids we don’t get enough of in the Standard American Diet. It’si’mportant we get more of these than Omega-6’s so we can desensitize the trigeminal nerve, decrease pain severity, and decrease pain days overall. Although it may be easier for you to take them as a supplement, it is better to get them in your food, and more affordable. However, if you do not like any of these foods, it is typically recommended to get them in supplement form (aka Fish oil). Ask your doctor before you change or start a new supplement.
Ramsden, C. E., Zamora, D., Faurot, K. R., MacIntosh, B., Horowitz, M., Keyes, G. S., Yuan, Z.-X., Miller, V., Lynch, C., Honvoh, G., Park, J., Levy, R., Domenichiello, A. F., Johnston, A., Majchrzak-Hong, S., Hibbeln, J. R., Barrow, D. A., Loewke, J., Davis, J. M., … Mann, J. D. (2021, July 1). Dietary alteration of N-3 and N-6 fatty acids for headache reduction in adults with migraine: Randomized controlled trial. The BMJ. Retrieved October 5, 2021, from https://www.bmj.com/content/374/bmj.n1448.
Although there is a distinct difference between these two inner ear conditions, one can play a role in the other occurring. Benign Paroxysmal Positional Vertigo or BPPV is a type of true, room-spinning, vertigo caused by the displacement of otoconia from your otolith organs within your inner ear. Endolymphatic Hydrops, both Primary and Secondary, is related to a pressure-volume issue in the membranous part of your inner ear, which causes dizziness, sometimes vertigo, ear fullness, hearing loss, and more.
Before we get into the relationship between the two conditions, let’s understand what’s happening in each diagnosis.
Benign Paroxysmal Positional Vertigo
BPPV is the most common form of vertigo, and most of the time we have no idea why it happens. Tiny ear crystals, otoconia, fall out of the space they belong and into the semicircular canals, most commonly the posterior canal. When this happens, the otoconia sliding through the canals when you move your head causes nystagmus, or involuntary eye movement. This nystagmus then makes it look like the room is spinning. If you’d like more info on BPPV and nystagmus, click here.
Primary and Secondary Endolymphatic Hydrops
Primary Endolymphatic Hydrops, AKA Meniere’s Disease, and Secondary Endolymphatic Hydrops are a result of an inner-ear pressure-volume relationship dysfunction. Endolymph is the fluid within your ear canal, it is high in sodium, and water osmoses between the endolymph and the perilymph on the other side. When there is too much fluid, because of the laws of physics, more fluid goes toward the endolymphatic portion of the inner ear, causing swelling of the endolymphatic membrane.
In the photo below, you can see two distinct colors. The first is the brown color – that is the bony labyrinth – this depicts where perilymph, the fluid high in potassium, resides. The pinker color illustrates where the endolymph is. Not pictured is the endolymphatic sac, a large protrusion toward the semicircular canals, that acts as a residual area for endolymph to swell. This swelling can push up against the vestibular nerve, causing hearing loss and dizziness. Additionally, the swelling due to an imbalance, that is not corrected quickly, can cause BPPV.
Why Benign Paroxysmal Positional Vertigo?
BPPV and Endolymphatic hydrops are related because the pressure fluctuation that happens during an episode of Endolymphatic Hydrops causes the otoconia to fall ‘out’ of the organs where they belong. There is not a lot of research that has been done to back up this information. There is some info, which I will cite throughout the rest of this article, but nothing that is totally evidence-based to back up this information. However, anecdotally, I see this quite frequently in my practice, and many other clinicians do as well, and there are a few theories.
Evidence for BPPV in Patients with Meniere’s Disease
This article, is a case review of 162 people, 9 of whom absolutely have Meniere’s Disease and the remaining had some reason to believe they did. This article only focuses on the 9 people with absolute Meniere’s Disease diagnoses, and within those 9 people, all had BPPV affect their ear, and one bilaterally. This shows that when you have Meniere’s Disease you’re more likely to have BPPV in that affected ear.
This article states two important pieces of information. The first is that most of the time, people who get BPPV have no underlying ear condition – it just happens at random. This is good because it really decreases the number of people we need to consider having vestibular conditions. However, it also states an important fact, which is that people who do have underlying vestibular conditions are more likely to have BPPV. It’s important to recognize this because knowing that you may have BPPV can make it less frightening if and when it happens. Additionally, it also states that inner ear diseases can indeed be to blame for detaching otoconia from where they belong.
The last article I will mention here is the closest I can find to solid research, rather than case studies, on this issue. This article talks about the different vestibular pathologies causing BPPV and the likelihood that BPPV is caused by a primary vestibular disorder, which in this case is referred to as Secondary BPPV. Secondary BPPV is likely underdiagnosed in comparison to Primary BPPV. This is because we often just treat the BPPV with an Epley, or other, maneuver and then not look into it further, even when it is recurring. However, if your BPPV is recurring, it’s so important to look deeper into how you could prevent this.
How do We Prevent BPPV?
Secondary BPPV is the term used to describe BPPV that’s occurring because of an underlying condition. By definition, your vestibular condition must be on the same side as where you have BPPV. So, if you have Meniere’s Disease, you’re more likely to have BPPV on the side where your Meniere’s Disease is as well. The same thing goes for Secondary Endolymphatic Hydrops, Vestibular Migraine, and Vestibular Neuritis. Preventing BPPV is not really possible in primary BPPV, because by definition it happens for no reason, but if there is a relationship between Meniere’s Disease, Secondary Endolymphatic Hydrops, or another vestibular condition you may have control over this.
Secondary Endolymphatic Hydrops is different from Primary (AKA Meniere’s Disease) because it is more predictable and not as degenerative as Meniere’s Disease. Preventing a flare of either though can be a challenge. Here are some tips:
Meniere’s Disease Prevention:
Eat a low sodium diet
Eat a low sugar diet
Avoid caffeine
Avoid alcohol
Exercise regularly
Medication
Stay hydrated
Track the weather patterns
Secondary Endolymphatic Hydrops:
All of the above, but track your triggers
Tracking your triggers is important with Secondary Endolymphatic Hydrops as you will be able to see what flares up your vestibular system most.
Check in about allergies
Again, Secondary Endolymphatic Hydrops is simpler to control than Meniere’s Disease, and although not simple, tracking your triggers will help you determine what may be causing the recurrent BPPV.
Other Causes of Secondary BPPV:
Vestibular Migraine: “the prevalence of migraine in patients with BPPV was twice as high as that in age- and sex-matched controls” Vestibular Neuritis: “The incidence of vestibular neuritis among BPPV patients has been reported within the wide range of 0.8–24.1%”
Dizziness and vertigo are both symptoms of many physical health disorders, most frequently vestibular disorders.
The words dizziness and vertigo are given many definitions by doctors and patients alike, however they are not the same thing, and do have specific definitions. So, what is the difference between dizziness and vertigo?
The difference between dizziness and vertigo is in their definitions; they have distinct differences and it’s important that we distinguish one from the other. The distinctions are important to help your clinicians understand how you are feeling, and to make sure you have an accurate diagnosis.
Dizziness is an umbrella term. Dizziness can subjectively mean anything from lightheadedness and unsteadiness, to imbalance or vertigo. Dizziness needs to be broken down into what you are feeling more specifically, you should use your own terms to define how you are feeling. Many of my patients are at first nervous to describe how they’re feeling as the words they’re using dont sound ‘medical enough’. However, those non-medical terms are exactly what I am looking for in a description of your symptoms. Your Vestibular Therapist and other providers want to know if you feel like you have a hot air balloon in your head, if you’re floating, or bouncing.
On the other hand, vertigo is the incorrect perception that you, or the room around you, are moving. This can feel like spinning, bobbing, swaying, or whirling. Vertigo is commonly associated with a few different diagnoses, just like dizziness is associated with other diagnoses. Vertigo, although it is under the dizzy-umbrella, is not most of the symptoms of dizziness. Vertigo is NOT: lightheadedness, fogginess, imbalance, or feeling like you have a hot air balloon in your head. Vertigo is the false perception of movement.
Vertigo is a symptom, not a diagnosis. If you leave the doctor, emergency department, or other provider’s office and have received the diagnosis “you have vertigo,” do your best to ask more questions. You cannot just have vertigo, you must have another condition that is causing the vertigo. The most common diagnoses that cause vertigo are: Benign Paroxysmal Positional Vertigo, Vestibular Neuritis, Vestibular Migraine, and Meniere’s Disease. There are a few other causes of Vertigo, such as stroke, head injury, and tumors. These are less frequent, but should be ruled out for safety reasons.
Dizziness and vertigo are typically caused by vestibular dysfunction, and it’s important for your doctor and healthcare team to recognize this and treat you appropriately. Seeking a vestibular diagnosis further than “you have vertigo” with an unknown cause, it so important to getting proper diagnosis and treatment for your vestibular disorder.
Migraine and Vestibular Migraine can be reduced and managed naturally with vitamins, minerals, diet, and exercise! People often ask me which vitamin deficiencies cause migraine and if you should be tested. Although your doctor can test you, that’s not a requirement as most people with migraine do have issues with these deficiencies in most research. These vitamins include Magnesium, CoQ10, D3, Riiboflavin (B2), and Omegas!
Natural migraine treatments can be paired with your medical treatment, however, be sure you tell your doctor what you’re taking as some vitamins for migraine can have an impact on your prescription medication – there are always options, so its best to be safe!. Some people use natural migraine treatment alone, without the need for Here’s a list of vitamins and other accessible over-the-counter treatments you can try. As always, ask your doctor before you change or add anything to your treatment plan!
The most common supplements for Vestibular Migraineurs are CoQ10, Magnesium, and Riboflavin (B2). Some supplements, like Migralief have all 3 combined, which makes remembering to take it easier. However, sometimes just because it’s easier doesn’t mean it’s better – some of my patients have been very successful with taking Migralief, but others have needed to take each one separately for multiple reasons.
Magnesium has so many purposes in our bodies. It helps with mental clarity, digestion, nerve function, blood sugar, and more! Taking keeping magnesium available in your body for use is called bioavailability. Different kinds of magnesium supplements help with different difficulties you may have related to migraine
Magnesium glycinate is used for mental clarity and digestive health, without causing digestive issues or a crash at the end of the day. Glycinate is an amino acid that your body uses to fight inflammation and improve sleep. Magnesium glycinate also occurs in foods such as meat, dairy, and legumes. Since those on a Migraine Diet or Heal Your Headache diet may be avoiding most dairy and some legumes, glycinate may be lacking in your diet. It’s important we have all the necessary amino acids in our diets, so a magnesium glycinate supplement may be a great idea for you!
Magnesium L-Threonate is when we combine threonic acid and magnesium. This form of magnesium is a formed to be easily digestible and is great for mental clarity. Studies have shown that it helped promote learning and memory, and helped prevent memory decline. Threonate is already present in some level in our cerebrospinal fluid, and the presence of extra in neuronal cultures “increased functional synapse density” (2). Really good Magnesium Threonate, like the kind form Pure Encapsulations, is really hard to come by. If you can’t find it from Pure Encapsulations on Amazon, they have another show online here.
Magnesium Citrate is often used for treating digestive issues, such as constipation. Magnesium citrate is the most available form of magnesium – this is the kind of magnesium that you find generically in stores. This form of magnesium is also commonly found in powder form. If you have trouble with the bathroom in general and are a person who deals with chronic constipation it might be good to take Magnesium Citrate. However, if you do not, be more cautious about this – you might spend a little extra time in the bathroom than you had intended if you take Magnesium Citrate.
Coenzyme Q10, or CoQ10, for migraine is used for preventing oxidative change in your brain. Migraine Brains hate change – so preventing large changes in oxidative stressors within your brain will help decrease the number of migraines in your life. CoQ10 helps support mitochondria by creating adenosine triphosphate, which helps us with energy (3, 4). Some studies have shown that CoQ10 can help with episodic migraine prevention up to 15 episodes per month. CoQ10 is made by Pure Encapsulations, like Magnesium, in pill form which is of high quality. It is also in chewable gummies made by NOW Supplements which patients have reported is effective as well.
Riboflavin, which is a form of B2 vitamin, is effective in preventing migraine (5). Migraineurs are frequently B2 deficient, so supplementing your body this vitamin can be incredibly helpful in migraine prevention. Riboflavin is generally well tolerated, affordable, and will likely make you feel better. In the study, of people who took Riboflavin for the 3 month trial, 59% reported decrease in migraine symptoms by at least 50%. Riboflavin is useful in brain function, skin cell production, gut/digestive lining, and more. People who have migraine are typically deficient in B2, so it’s a good idea to supplement it into your diet. B2 can be found in eggs, milk, meat, nuts, enriched flour, and more If you do not tolerate these foods well, especially if you’re on a strict migraine diet, it could be a good idea to supplement it in vitamin form instead of trying to eat enough throughout your day. The typical dose is 400mg/day for at least 3 months, but as always, ask your doctor for more information!
It is significant, however, that riboflavin has been shown to interact with some medications like antidepressants and some cancer drugs, so be sure to check with your doctor first!
A new study found that having more omega-3’s than omega-6’s is helpful for preventing pain and migraine frequency/days. We have two main forms of Omega-fatty-acids in our bodies. The first is Omega-6 and the second is Omega-3. Omega-3 has long been known to be healthier and better to have more of in your body. You can find it in avocados, fatty fish, and other nutrient-rich foods. Its other form is Omega-6, and is known not to be as healthy. This study found that increasing the number of Omega-3’s a person had, without doing any alteration of Omega-6, decreased headache frequency. Both Omege-3 and -6 are not synthesized internally, meaning that we have to eat them to get them in our bodies, or we have to supplement them or eat them!
New research shows that melatonin could be very helpful in treating vestibular dysfunction. MT1 receptors interact with melatonin, and are found all over the same parts of the brain that the vestibular system is! This study says “melatonin has been proposed as a prophylactic agent in the prevention of migraine attacks, a condition that can be associated with vertigo” (8). This study also states that in animal models melatonin has been found that it can be otoprotective (protective for the ear). 3mg was taken daily during this study, and it should be taken at night before you go to bed. This way you can not feel extra sleepy during the day.
Vitamin D3 can be helpful in preventing vestibular migraine, but the mechanism is not clear. There is not a lot of evidence to recommend it to all patients with migraine or vestibular migraine, but it’s great to ask your doctor if it’s a good fit for you. Many people are vitamin D3 deficient, especially with migraine. There is some evidence to show that there is a decrease in migraine frequency and pain when vitamin D3 is supplemented. This is especially important when it is not sunny outside, or if you live in a particularly foggy place! We get D3 via UV waves, but if we don’t live in a sunny place, or you live in a house/apartment without a lot of light, it’s important to find a way to get it in. Supplementation is frequently the answer here!
(5) Schoenen J, Jacquy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology. 1998 Feb;50(2):466-70. doi: 10.1212/wnl.50.2.466. PMID: 9484373
(6)Wolff, A. (2020, April 5). The Best Magnesium Supplements for Migraine. The Dizzy Cook. https://thedizzycook.com/magnesium-supplements-explained-which-one-is-best-for-vestibular-migraine/
(7) Ramsden, C. E., Zamora, D., Faurot, K. R., MacIntosh, B., Horowitz, M., Keyes, G. S., Yuan, Z.-X., Miller, V., Lynch, C., Honvoh, G., Park, J., Levy, R., Domenichiello, A. F., Johnston, A., Majchrzak-Hong, S., Hibbeln, J. R., Barrow, D. A., Loewke, J., Davis, J. M., … Mann, J. D. (2021, July 1). Dietary alteration of N-3 and N-6 fatty acids for headache reduction in adults with migraine: Randomized controlled trial. The BMJ. Retrieved October 5, 2021, from https://www.bmj.com/content/374/bmj.n1448
(8) Joaquin Guerra, Jesus Devesa, “Melatonin Exerts Anti-Inflammatory, Antioxidant, and Neuromodulatory Effects That Could Potentially Be Useful in the Treatment of Vertigo“, International Journal of Otolaryngology, vol. 2021, Article ID 6641055, 6 pages, 2021. https://doi.org/10.1155/2021/6641055
(9) Nowaczewska M, Wiciński M, Osiński S, Kaźmierczak H. The Role of Vitamin D in Primary Headache-from Potential Mechanism to Treatment. Nutrients. 2020;12(1):243. Published 2020 Jan 17. doi:10.3390/nu12010243
Learning to live with Vestibular Migraine is a life-long process, but tips and tricks from those with Vestibular or other forms Migraine can be so helpful. However, it is sometimes hard to find an all inclusive list of things that people have found helpful in the past. This is a list, which will be continually updated, containing items that patients have found to be helpful!
The Allay lamp’s intention is to decrease migraine triggers by emitting a calming green light that is proven to decrease photophobia, anxiety, and stress. We know that there are many wavelengths of light, which make up the whole world of colors, but for those with Migraine most of those lights are intolerable. Wearing migraine glasses is one solution, but another is to use this lamp. This lamp triggers small electrical responses in your brain, instead of large electrical signals that most bands of light cause. You can dim it, place a shade on one side for decreased light overall, or change it to a whiter light that is still soothing.
Migraine Glasses
There are so many pairs of glasses my patients have found to be helpful. Migraine glasses are intended to block blue light, in addition to yellow and other waves of light. Blue light ranges from 400-750nanometers. Because it is such a wide range, different kinds of blue lights are more and less problematic for your migraine and related symptoms. Some blue light glasses block only some parts of the blue light spectrum, even the parts that are good for you. Blue light around 460-500nm is actually healthy – we use blue light to monitor our melatonin levels, which affects our sleep-wake-cycle. Blue light can even be used to treat Seasonal Affective disorder. Blue light below 430nm is the “bad” blue light. The intention for a good pair of blue light blocking glasses is to block the blue light under 430nm. Special migraine glasses, like Theraspecs and Migraine Shields, and AxonOptics glasses do just that!
Theraspecs are the pair of glasses I let patients use in the clinic. I really like them as the pink hue from the FL-41 glasses are soothing for many of my patients, and they were created by a person in the Migraine Community. According to their website, TheraSpecs wearers experience 74% fewer migraine attacks on average per month, which for people with photophobia (light sensitivity) will make a huge difference. Even if you aren’t sensitive to light, Theraspecs will make a difference!
Theraspecs work to block the harmful blue light waves, provide wrap around protection of your eyes, and focus on blocking blue light the most at 480nm, the most aggravating wavelength for those with Migraine.
Migraine Shields are the best pair of glasses if you don’t want any color distortion in your vision. Most migraine glasses have FL-41 lenses, which are tinted pink – Migraine Shields uses a slightly different technology and aren’t tinted pink. These are great for work environments, using the computer, or choosing anything where color might be important. Migraine Shields do not come in a large enough size to fit over other glasses if you have a prescription! However, Migraine Shields have just released readers. These readers come in many shapes, sizes, and are so much cuter than the ones you find at the drugstore – these really multitask and are SO helpful!
AxonOptics are also a great option for Migraine relief. They are not too pink, lightweight, and come in three different tints. AxonOptics glasses have three tints for three intentions: indoor, outdoor, and transitional. Transitional lenses take a little longer to make, and they are a little more expensive. However, if you are going to purchase 2 pairs anyway, it may be worth it.
Research has found that FL-41 lenses need to be specifically made for people with light sensitivity. AxonOptics creased their specific glasses for Migraine by crafting a lens that is consistent, effective, and a nice color. Additionally AxonOptics has a plethora of frames you can choose from, and an option for contact lenses.
These can also be in the form of prescription eye glasses – if you’d like them to fill your prescription they can do that so you can still be working with these on!
Why Not Just Wear Sunglasses?
Sunglasses, while they may provide relief for your migraine in the moment, block too much light. If light is a trigger for you already, you don’t want to make it an even bigger trigger than it is already. When you wear sunglasses all day, inside and outside, it blocks many wavelengths of light, not just those in the blue light spectrum which work to block the provocative forms of blue light. If you block many kinds of light, not just the ones that typically affect migraine, you may end up sensitizing yourself too all light, making your triggers worse!
The headache hat is a tool you can use to soothe the headache part of your Vestibular Migraine, if you have them. I have found that patients in the middle of an attack will get their headache hat from the freezer, and feel at lease some relief. I would put the entire thing in the freezer, so you don’t have to deal with putting it together when you’re in the middle of a Migraine attack. It’s an easy, natural, way to give yourself a little relief.
Imperfect Foods is a weekly delivery of produce, meat, dairy, and snacks that is completely customized to your liking. You can choose what you’d like to go into the box, and they’ll deliver it to you on a set day for your whole neighborhood. I love Imperfect Foods, as they deliver the food that would normally be thrown out by grocery stores – your produce sometimes looks funny or misshapen, but is perfectly consumable!
They have options for organic or non-organic, and many other fun products that will make your life easier for when you really don’t want to go to the grocery store!
Ritual Zero Proof is a whiskey, tequila, or gin alternative that tastes like the real thing, but without the alcohol! It really does taste like the real thing, but has no alcohol, no hangover, and no migraine! This was started by three people who do drink but wanted an additional way to enjoy a cocktail that wouldn’t give them the tipsy feeling. Although not intended for a vestibular migraine diet, it fits perfectly into your lifestyle!
Sulfites and histamines can be part of your trigger load. Because wine, and other food & beverage categories, can contain quite a few sulfites finding ways to avoid, or remove, the sulfites is helpful! PureWine Wands remove the sulfites from the wine, which are produced by the grape skins during fermentation, and naturally occur in almost all, if not all wines. Removing these will help, but make sure you follow the directions as they do have to sit for a while to be effective.
There are a few books that Migraine patients should read, whether you have Vestibular Migraine or another kind of migraine. These will all help you understand Migraine and how to manage your symptoms
This book is by well-known neuro-otologist, Dr. Shin Beh. He goes through the steps from finding out you have Vestibular Migraine to learning what to do next in order to manage your Vestibular Migraine symptoms. This is an absolute must-read for all vestibular migraine patients – either if you have a new diagnosis or you’ve been managing your symptoms for a long time.
This was the first Migraine book I read when I started treating patients with Migraine. It really helped me understand the vastness of triggers a person can have, how to manage the symptoms, and what a migraine actually is. It’s around 300 pages, but it’s a quick read and it has charts in the back to help you analyze your migraine!
This book will give you a step-by-step guide for dietary recommendations for migraine and vestibular migraine. It will take you through the elimination and reintroduction of foods into your diet for a successful migraine lifestyle!
This is a short list of many Vestibular Migraine Hacks that will help make your lives easier! Check back soon for more helpful products and tips as this list grows!
Let’s talk about being dizzy!
Everyone has probably been dizzy at some point, whether you spun around in a circle too many times, or stood up too quickly, you might know what it feels like to be dizzy! Dizziness has many causes, one of the causes is vestibular, but the feeling of being dizzy is not always an inner ear issue. In reality, it is a a big umbrella term for many different symptoms that present themselves and make you feel differently than you are used to. Because there are so many causes of dizziness, it’s important that your provider understands how you are feeling, when you’re having the sensation, and how long it’s lasting. Dizziness symptoms can be present when someone has low blood pressure, a racing heart, or if you are dehydrated. Those are just a few of the many examples that are not vestibular that could be causing your symptoms. It is for this reason that doctors often have so much trouble with finding the answer to why you specifically are dizzy.
Whether you experience vertigo, spinning, dizziness, lightheadedness, or feel like your head is a hot air balloon, your experience is real and valid. Simultaneously, it is very important to put a name on your specific feelings. Most of your diagnosis will likely come from your subjective feelings – whether you’re swaying, lightheaded, or spinning, your doctor will use this description to help provide you with a diagnosis.
I sometimes find that my patients and clients caveat their symptoms with “I don’t have a good word for this, it’s almost like I am _____” and insert a descriptor like ‘cotton candy headed’. This description is not wrong. All people have different descriptions of dizziness and vertigo because no two people are exactly alike. Your specific description and experience should be incredibly important to you and your healthcare provider in order to come to a diagnosis. The ability to illustrate your specific symptoms will help a healthcare provider determine the best form of treatment for you specifically.
Although vertigo and dizziness can be incredibly frustrating, and hard to describe, there is comfort in the fact that vestibular dizziness can be treated through physical therapy and other healthcare avenues. The description, even though it may feel impossible to describe, is very important to your PT. If you feel like you absolutely can’t put a word on it, say that. Tell your provider that it feels impossible, or lightheaded, or like you’re floating. This will help us determine if you have BPPV, a form of Endolymphatic Hydrops, Vestibular Neuritis, or another vestibular dysfunction. No matter the kind of dysfunction, the ability for your physical therapist to reproduce your symptoms of the most important part of treatment. It is likely that during your evaluation you will be dizzy for a portion of the time. This is normal, but if you are know you’re prone to excessive dizziness and discomfort, bring someone to your appointment to help you get home.
Time is another very important factor in dizziness. How long, how often, and when your symptoms occur is another vital piece to what is causing your dizziness. If your dizziness only happens when you stand up too quickly, your doctor should think one thing, like low blood pressure, but if it happens because you move your head quickly, it may be vestibular and movement related. How long the symptoms last is also important as it will help you doctor conclude if you’re sensing movement incorrectly, or if you have a mechanical problem, like BPPV.
There is no right, or wrong, answer when it comes to your dizziness and your symptoms. Ruling out non-vestibular issues first, like cardiac dysfunction, is part of ruling-in a vestibular diagnosis, but is not the only part of your equation. Some people have more than one kind of dizziness, and that is not abnormal. Try not to become overwhelmed, always talk to your doctor & healthcare team, and bee honest about what is happening with you!
No matter what, we are here to help!
Nystagmus is a word we use in vestibular rehabilitation very frequently. It is an involuntary, uncontrolled, repetitive eye movement. There are two phases of nystagmus, the fast phase and the slow phase. The fast phase is the direction the eye is moving, and the slow phase is a resetting saccade to place the eye back in the middle. Nystagmus is described by the direction it moves toward during the fast phase. Nystagmus can move in almost any direction, its direction is completely dependent on the diagnosis. These include, but are not limited to: Benign Paroxysmal Positional Vertigo (BPPV)Benign Paroxysmal Positional Vertigo (BPPV), Vestibular Neuritis, and Ménière’s Disease. The nystagmus is the cause of your true spinning vertigo symptoms, which is different from other kinds of dizziness.
Your healthcare provider, like a physical therapist or physician, will examine your eyes to observe the nystagmus. We use your nystagmus’ direction to determine the affected ear, canal, and/or nerve that is causing your symptoms. In some cases, you will need to turn your head or move your eyes, so be sure to listen and keep your eyes open through the duration of your testing unless directed otherwise.
The following chart lists the kind of nystagmus and it’s coordinating diagnosis for Benign Paroxysmal Positional Vertigo:
BPPV Diagnosis
Nystagmus
Position
Right Posterior Canal Canalithiasis
Right Up beating Torsional Nystagmus
Right Dix-Hallpike Position
Left Posterior Canal Canalithiasis
Left Up beating Torsional Nystagmus
Left Dix-Hallpike Position
Right Horizontal Canal Canalithiasis
More intense Right Geotropic Nystagmus
Right Roll Test (compared to Left Roll Test Position)
Left Horizontal Canal Canalithiasis
More intense Left Geotropic Nystagmus
Left Roll Test (compared to Right Roll Test position)
Right Horizontal Canal Cupulolithiasis
Less intense Right Ageotropic & more intense Left Ageotropic nystagmus
Right or Left Roll Test position respectively
Left Horizontal Canal Cupulolithiasis
Less intense Left Ageotropic & more intense Right Ageotropic nystagmus
Left or Right Roll Test position Respectively
Right Anterior Canal Canalithiasis
Down beating (and sometimes torsional) Nystagmus
Left Dix-Hallpike Position
Left Anterior Canal Canalithiasis
Down beating (and sometimes torsional) Nystagmus
Right Dix-Hallpike Position
BPPV is not the only vestibular diagnosis that is associated with nystagmus. Acutely, a superior nerve vestibular neuritis (the most common form) will cause spontaneous nystagmus for 12-36 hours. This will present as a horizontal nystagmus that beats away from the affected ear (toward the unaffected year), and will not change direction with the direction of gaze. However, the nystagmus will increase, or become faster, when you look in the direction of the nystagmus. This effect is called Alexander’s Law; nystagmus will continue to beat in the same direction, regardless of gaze, but it will increase when your gaze is in the direction of your nystagmus. If you catch these symptoms within the first 24 hours, a prescription for a steroid from your physician will help your long term outcomes.
Diagnosis
Symptoms
Right Vestibular Neuritis (superior branch)
Left beating horizontal nystagmus, increasing with left gaze
Left Vestibular Neuritis(superior branch)
Right beating horizontal nystagmus, increasing with right gaze
Nystagmus doesn’t only occur due to vestibular disorders, it can also be caused by a central nervous system dysfunction. These central disorders are usually due to brain stem or cerebellar degeneration or dysfunction. Central nystagmus will present at rest as down beating, up beating, or pendular nystagmus. However, central nystagmus can also be gaze-evoked. Gaze evoked nystagmus will increase to the right when you gaze right, and increase to the left when you gaze left.
All nystagmus can cause dizziness and vertigo, but distinguishing between central and peripheral (vestibular) causes of nystagmus is essential to your treatment. If you have a peripheral disorder your best treatment may be from a physical therapist, and if you have a central disorder care from a physician and other healthcare providers, including a vestibular physical therapist, will be your best option. Always talk to your healthcare team about nystagmus, vertigo, dizziness, and other symptoms you may be experiencing.
BPPV, Benign Paroxysmal Positional Vertigo, can be easy to diagnose subjectively, but watching eyes can be difficult. The following is a chart illustrating the direction of eye movement, position of your patient’s head, and the corresponding diagnosis.
BPPV Diagnosis
Nystagmus
Position
Right Posterior Canal Canalithiasis
Right Upbeating Torsional Nystagmus
Right Dix-Hallpike Position
Left Posterior Canal Canalithiasis
Left Upbeating Torsional Nystagmus
Left Dix-Hallpike Position
Right Horizontal Canal Canalithiasis
More intense Right Geotropic Nystagmus
Right Roll Test (compared to Left Roll Test Position)
Left Horizontal Canal Canalithiasis
More intense Left Geotropic Nystagmus
Left Roll Test (compared to Right Roll Test position)
Right Horizontal Canal Cupulolithiasis
Less intense Right Ageotropic & more intense Left Ageotropic nystagmus
Right or Left Roll Test position respectively
Left Horizontal Canal Cupulolithiasis
Less intense Left Ageotropic & more intense Right Ageotropic nystagmus
