Dietary Considerations for Vestibular Migraines and Endolymphatic Hydrops

Treating your symptoms through dietary changes and some restrictions is the first step in treating many vestibular disorders. In the clinic, I always begin my evaluations by asking questions about their symptoms, their experience with dizziness and vertigo, and what their diet and exercise habits look like. Habits can be difficult to break, and as you read this, know that I have no intention of completely overhauling your life if it’s not something you want. I always say to my patients before we begin: “I don’t want to take over your life as we solve this together”. I say this not because ever I take over lives, but because big changes like this can seem daunting and intimidating. I like to start small and work toward bigger changes when necessary. Luckily, many of these things may be temporary, and some foods may be reintroduced when you have been steady and successful handling your dietary needs. As always, talk to your healthcare team prior to starting a new diet!

Let’s first start with some simple strategies.

Distribute your food throughout the day

Evenly spacing your food by eating at regular intervals helps your body maintain fluid levels, and avoids fluctuating high and low blood sugar levels. Decreasing big fluctuations during your day reduces the possibility of triggering a migraine or a hydroptic episode.

Avoid heavily processed foods, eat a whole food diet

A diet that consists of whole, unprocessed, foods can be difficult and make us focus on what we cannot have instead of what we can have. Instead of taking away your favorite foods, focus on adding fruits, vegetables, and whole grains to your diet. Processed foods tend to be high in sugar and sodium which are often triggers for migraines and hydroptic episodes. Items that we forget are high in sugar and sodium are juice, some sparkling water, iced tea, and canned fruits and vegetables.

Drink plenty of fluids

Drinking enough fluid, while spacing it throughout the day, is important to keep your fluid levels even instead of letting them fluctuate largely up and down. Try to get into the habit of bringing your water bottle with you on the go instead of only drinking during breakfast or dinner when you’re home. Lastly, try to avoid drinks with high sodium, sugar, or caffeine, and remember that tea and sparkling water often are high in sugar, caffeine, and/or sodium.

Don’t use tobacco or nicotine

We all know that smoking cigarettes isn’t good for your lungs, heart, or any of your body in general. Here, we can add dizziness-trigger to the reasons to avoid tobacco at all costs. 

Avoid, or even eliminate, alcohol

Alcohol is a trigger for both vestibular migraine and secondary endolymphatic hydrops. The fermentation process, sulfites, and additional chemicals are what trigger the response. Some individuals with vestibular migraine can get away with clear liquors and organic white wine, but I usually recommend staying away from alcohol in general until you have been steady with your diet and symptoms for a few months.

Ask your physician about vitamin and supplements you may be taking or want to take

You may be taking some supplements or vitamins, and these may be things you’ve taken for a long time. However, some vitamins and supplements can be problematic if you have migraines or endolymphatic hydrops. 

Next let’s break down more specific dietary guidelines. 

Again, it is unlikely that each and every one of the items on this like will be a trigger for you. Eliminating them for 3-4 months and then slowly adding them back in will make you most successful. I recommend that my patients start by adding back things they’re having the hardest time living without for 1 week. After you add one food back in, be aware if you have an episode in that week, if you don’t go about eating it as you please!

Salt and sodium

Sodium is an essential part of our diet, and we need it to function. However, too much for a person with vestibular migraine or endolymphatic hydrops can be detrimental. It is advised for most people to have less than 2,400mg of sodium per day. If you are eating a low sodium diet for our purposes here, eating 1,000-2,000 mg/day is recommended. Sodium is found in many sources that we wouldn’t normally think of. Be wary of sports drinks, sparkling water, and canned foods! Be sure to ask your provider for his or her recommendations before making changes to your diet!

Sugar

Sugar is another substance that we should avoid as much as we can. It hides itself inside almost everything we eat, from fruit to table sugar. Fruit sugar is a complex sugar, and is pretty impossible to get rid of entirely — and honestly I wouldn’t recommend anymore completely get rid of all sugar. Some sugar is important in any diet, however reducing the amount of sugar you’re eating daily, especially simple sugars like table sugar, candy, and honey can be beneficial.
Your healthcare providers can help assist you in exactly what this should look like for you, but reading the labels and not eating processed sugary foods is a great start! You can also talk to your provider about substitutes for sugar like aspartame and sucralose can be a good way to sweeten things you’d usually use table sugar for. However, be aware that some artificial sugars are high in sodium, which we are also trying to avoid. Always be sure to read the packaging!

Caffeine

Caffeine is often a trigger for increasing tinnitus and other symptoms as it is a diuretic.
Caffeine has a reputation for actually being good for migraines as it is a stimulant and therefore dilates our blood vessels leading to temporary migraine relief. But in reality it can lead to a rebound headache and doesn’t help to relieve your caffeine addiction overall. Some people switch to decaffeinated coffee, however there is 0-7mg of caffeine in a cup of decaf coffee as well as other chemicals that can trigger a migraine because of the way coffee is decaffeinated.
Caffeine is also problematic for endolymphatic hydrops because of its diuretic effects. If you are chronically excreting urine from drinking caffeine it will be detrimental to keeping homeostasis and balanced fluids in your inner ear. This is different from a prescription diuretic, as it doesn’t excrete a constant amount of fluid throughout your day, leading to an unwanted fluctuation. The changes in fluid balance is what we are looking to avoid, and caffeine from sources including coffee, tea, chocolate, can cause these fluid fluctuations. 

Monosodium Glutamate (MSG)

Monosodium Glutamate is a chemical we all think we avoid, but it’s hidden in many foods where we don’t know it’s hiding. MSG is high in sodium and therefore can cause a severe episode. It is found in cured meats, fast food, chips and seasonings, canned soup, and instant noodles. Be sure to read the packing before you buy or eat a prepackaged food. MSG has different names such as:  monosodium salt, monohydrate, monosodium glutamate, monosodium glutamate monohydrate, monosodium L-glutamate monohydrate, MSG monohydrate, sodium glutamate monohydrate, UNII-W81N5U6R6U, L-Glutamic acid, monosodium salt, and monohydrate. Seeing any of these on a food label signals that it’s something to be avoided. 

Nuts, Nut Butters, & High Histamine foods

Nuts are triggers for both vestibular migraine and endolymphatic hydrops. The first reason nuts may be problematic is because most of them are salted. However, nuts also contain histamine, which often trigger migraine symptoms. Other foods high in histamine are fish, citrus fruits, and aged cheeses. 

I know that this list is long!
Taking the time to understand what triggers impact you and stabilizing your symptoms is super important. I recommend keeping track of exactly what you eat and when you eat it for at least 2 weeks, and trying to link it to times you become dizzy. You have the tools to independently handle your diagnosis, and treat it effectively through conservative measures!

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