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Jaw Pain and Dizziness: 5 ways to Manage TMJ and dizziness

Jaw pain and dizziness are related and have an interesting relationship. It can be challenging to know which one causes the other. This article outlines 3 ways TMJ and dizziness are related, including TMJ and migraine, and 5 ways to help mange TMJ pain and dizziness.

What is the TMJ?

TMJ stands for “temporomandibular joint”. This is where the mandibular fossa of the temporal bone of the skull and mandibular condyle of our jaw bone meet. This makes the joint we commonly refer to as the jaw. Some may say “I have jaw pain” and point to the TMJ, others may say “I have TMJ issues”.

Jaw pain and Dizziness — This image show the TMJ or temporomandibular joint. When discussing jaw pain, this tends to be the area many are referring to.

3 Ways TMJ Pain and Dizziness are Related

The anatomy around our jaw includes a lot of important systems that are connected to dizziness and migraine. Read below to learn how jaw pain and migraine, jaw pain and dizziness, and jaw and neck pain are related.

The muscles around the jaw and neck can refer pain to the ear. It may feel like there’s an ear infection starting, but it might actually be tightness in jaw or neck muscles, or inflammation around the TMJ.
Inflammation of the TMJ can influence the fluid balance of the innter ear via the eustachian tube. This can result in an imbalance of the inner ear, which can result in dizziness.
The trigeminal nerve stems from an area very close to our ear. The trigeminal nerve is involved in current migraine theory as a contributor to migraines and is connected to vestibular migraine. The trigeminal nerve is in charge of touch, temperature and pain sensations in most of our face. Part of the trigeminal nerves involvement in migraine is facial pain or pain behind the eye that some experience during a migraine attack.

How do I know if my Jaw pain and dizziness are connected?

The best way to find out if your jaw pain and dizziness are related is during an examination. If assessment of your jaw or neck recreate your symptoms or make current symptoms worse, it is something that should be addressed in your plan to improve your dizziness. Based on other findings from your exam, there might be other areas your provider would like to address first. In some cases, as other areas improve, TMJ or neck pain may improve naturally. If other areas start to improve but you’re still noticing TMJ or neck pain, then a more focused approach should be used. It’s an important conversation to have your with your medical team and your plan may change over time, so keep having those conversations!

5 ways to address TMJ Pain and Dizziness

Practice Tongue and jaw resting position. Your teeth should not be touching when your mouth is closed and at rest. Jaw should be relaxed. Tongue should be resting on the roof of your mouth, not on the back of your teeth.
Avoid sleeping on stomach. This places pressure on the TMJ and can contribute to pain and inflammation.
Avoid unnecessary jaw strain/movements (resting your head in your hand, super chewy foods like bagels, taking large bites of food, nail biting, gum chewing etc.)
Improve posture. Posture influences our neck and head position. Good posture can help address muscle tightness or poor jaw positioning that can impact TMJ pain. Good computer posturing is a great place to start. Computer moniotor should be be at eye level, keyboard should be where your arms can relax at your sides and your elbow makes a 90 degree angle, feet supported by the floor or stool to have knees at a 90 degree angle.
Frequent movement breaks. Getting up every 30-45 minutes for a movement break or changing positions. This will help improve posture and allow muscles a change to relax and avoid stiffness or tightness.
See a TMJ PT or TMJ specific dentist. Click here to use this directory to see if someone is near you.

Want to learn more about TMJ assessment, surveys, and TMJ exercises and other vestibular tools to get back to your daily life? Find out more at this link: https://tvd.flywheelstaging.com/about-group/

Disclaimer:

Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

Tips and tricks for traveling with a vestibular disorder

Travel plans can be popular this time of year to spend holidays with family and friends, warm vacation destinations, or other special occasions. Overall, no one really loves traveling, but it can be even more challenging with a vestibular condition.Read below to find some lists of our favorite travel tips with a vestibular disorder and for some specific to different travel types!

How to travel with a vestibular disorder: Preparation is key!

Here are our Top 10 effective tips to help prepare for your upcoming trip and traveling with a vestibular disorder successfully. Keep reading to learn more about how to travel with a vestibular disorder based on specific types of travel!

Make the first planned trip low key. A short trip or close destination is a good idea to test out traveling and make adjustments for future trips.
If staying in a condo or hotel, request a lower floor. This will help with any symptoms with heights and reduce time spent in an elevator (or just using the stairs!)
Make sure you have enough medication prior to your trip. If your meds run out while on your trip, get a refill before travel. Talk to your doctor if it’s a controlled substance to get a plan on how you’re going to have your needed medications for your trip.
Pack a small bag within your suitcase. This gives you something to easily carry important meds or your vestibular kit on day tips at your new destination.
Pack a vestibular travel kit. Pack all the things you use for symptom management in one bag. Make sure this bag is easy to access throughout your travels. Store it in your personal item or carry on bag if you have one. It may include:
1. Medications (rescue, preventative, over the counter etc)
2. Peppermint or ginger (candy or scented oil)
3. migraine/blue light glasses (we like avalux if you want to check them out here)
4. Hat
5. Ear plugs/noise canceling headphones
6. Snacks
7. Water
8. Travel pillow

6. Pack your own pillow. Having your own pillow helps ensure a good nights sleep at your new destination. Some people will order and ship a pillow similar to theirs to where they are traveling to cut down on packing!

7. Stay hydrated throughout your travel day. Taking additional breaks for the bathroom can help keep you active and use it as an opportunity to check in with yourself and take a break if needed.

8. Get a good night’s sleep the night before

9. Eat a good breakfast on travel day.

10. Try to stay active before and during travel. Light walks, different position changes while sitting, seated marches, seated kicks, standing heel raises or sitting/standing can help keep your body moving.

How to travel with a vestibular disorder based on transportation (car, train, plane, boat)

Traveling with a vestibular disorder by car

Driving is a common challenge I hear when working with those who have vestibular conditions. If you’re looking for more driving tips, check out our other blog post on driving here. This list is geared more towards longer driving trips to reach your travel destination. Let’s dive into how to travel with a vestibular disorder by car:

Pack ahead of time, if you notice something you’re using regularly, put it in your suitcase so you know you won’t forget it.
Pack up the car the night before
Sit in the front passenger seat, keep your eyes on the horizon
Listen to music or audiobooks for entertainment
If being the driver helps your symptoms, make sure you’re safe to do so! Talk to your doctor about returning to driving and make sure you practice driving for longer periods of time and learn your drive time limit.
Use gas stops/bathroom stops as time to take a movement break and do gentle stretching, exercise or walking. Use as a time for grounding as well.
If the drive is more than a few hours, consider flying to cut down on overall time traveling.

Traveling with a vestibular disorder by plane

Traveling by plane can be really daunting, especially after living with a vestibular condition. We at The Vertigo Doctor want you to consider flying as an option, especially if it cuts down travel time considerably. Less time spent with the stresses of traveling means the sooner you can start to rest, relax, and recover! Here are ways for traveling with a vestibular disorder by plane:

Have your vestibular travel kit with you on the plan and easy to access in the airport and during the flight
Give yourself plenty of time to reach your gate. Recommended time is usually 2 hours prior to your flight. If you’re not familiar with the airport, or it’s a large airport that involves shuttles, giving yourself more time to rest and ask for help can help reduce the stress of flying! If unsure, ask for help sooner rather than later!
Try to book direct flights
Try to avoid flying during really early or really late flights to avoid large shifts in your sleep routine
If changing time zones, try to slowly adjust your sleep schedule by 15 minutes the days prior to gradually match your time zone if possible.
Try to sit in the aisle and near the wings. This can help minimize any rocking from the plane and the aisle gives you ample opportunity to get up and move.
Try to avoid smaller planes that aren’t pressurized
A travel neck pillow or eye mask can help make yourself comfortable on the plane.
Ear planes are ear plugs made for air travel to help with pressure changes. Yawning or gum can also help with altitude changes
Ask doctor for any medication suggestions to help with plane (like a decongestant or rescue med if you don’t have one)

Traveling with a vestibular disorder by train

Trains might not be as common in the United States for longer trips, but these tips may help if you take a train for your daily commute. If you’re also trying to travel to another country or continent that uses trains more for travel such as Europe, check out these tips on how to travel with a vestibular disorder by train:

Face forward and on the aisle to avoid too much visual stimuli. Looking outside tends to be more challenging.
Take a short movement break at train stops.
If the train is moving and you need to get up, it’s okay to use your hands to touch the chairs or overhead luggage compartments for more balance when walking on the train.
If you have to stand, spread your feet wide to have more support, try finding a pole to hold onto to try to avoid holding your arm overhead for extended periods. If the overhead grips are the only thing available, try to alternate your arms every stop to get a rest.

Traveling with a vestibular disorder by boat

Whether it be by ferry or a an afternoon on the lake, boating is certainly a way of transportation to be prepared for! Here are some considerations when traveling with a vestibular disorder by boat:

Sit towards the center of boat to reduce rocking
Try to stay outside on the deck if possible.
Talk to your doctor about any recommended motion sensitivity medication to bring in addition to your vestibular travel kit
Sea band or acupressure bands can be helpful for some with sea sickness.

How to recover from traveling with a vestibular disorder

Congrats on your trip!
Remind yourself that some “off” sensation or feelings is normal for anyover after a lot of travel and it will get better.
Try a short walk to help “reset” the system
Get good night’s sleep
Grounding, meditation, relaxation.
Try to make the day after travel a calmer day. Something restful and relaxing. If you want to join a group that’s something more adventurous, try to get there a day early to recover and be ready for it!

If you found this article helpful, check out this other article on our site that has additional information on traveling with a vestibular disorder by clicking here.

Want to learn more about managing your vestibular condition with travel, return to driving, hormonal impacts, and other vestibular tools to get back to your daily life? Find out more below!

Click here

Disclaimer:

Holistic Management of Vestibular Migraine with Dr. Sheikh

Dr. Sheikh is very knowledgeable and has had extensive training to help address and manage headaches, and more specifically migraines. Dr. Sheikh got her MD and then completed her residency at MOntefiore Medical Center in Bronx NY. She then went on to complete two fellowships; a vascular fellowship and then a fellowship in “Headache and Facial Pain” Harvard Medical school and is now an adjunct professor at Ichan Medical school at Mt Sinai in New York City. Being in a clinic setting for over 6 years now, Dr. Sheikh has been treating and helping her patients manage complex headaches with a holistic approach. She’s very up to date on current medication options and other complementary treatments that she is sharing with us in Vestibular Group Fit!

Migraine is more than a Headache

“I like to think of migraine as a disease, and headache as a symptom…migraine is a genetic neurological disease and headache is a symptom of migraine”. Dr. Sheikh

Migraine is more than just a headache! Migraine may have a headache (not in all cases) but also vertigo and dizziness, light or sound sensitivity, brain fog, or visual auras. Headache associated with migraine is most reported disabling symptom, but others may have dizziness or sound sensitivity as their most prominent symptom. For a more indepth look at vestibular migraine, here’s a helpful article to review, click here.

How do we treat migraine holistically?

Your doctor should listen
1. Best management should be a discussion about your experience, your options, and creating a plan. Not just being given a prescription and nothing else. If a med is all you need and you’re interested in, great! Having the chance to discuss what you want and the options is key.
Remember, you have options
1. Don’t like the idea of medications? Meditation, diet, exercise, yoga, breathing, sleep and more can be a major part of your preventative plan. Sometimes medications are helpful in getting you feeling better to get a better foundation to manage holistically. You don’t need to be on meds forever but it can be a useful tool. Using medications is not a failure, just a tool that can be used daily, only during attacks, or never. This is why discussions are so important to address concerns and adjust your plan based on your responses for best results.
Reducing hypersensitivity (increasing your threshold)
1. Addressing your treatment holistically can reduce hypersensitivities and help increase your migraine threshold
Treat from all angles
1. Holistic and natural options are wide ranging and finding the ones that work for you can be super helpful in migraine management. Medications can range from a daily preventative, botox injections that are months apart, or an abortive med that’s only used to reduce your symptoms during a migraine.
Stress management
1. Stress can lower our migraine threshold and make you susceptible to an attack, the better we can use holistic approaches to manage stress, the better for not only your migraines but your overall well being!
Be prepared!
1. A common stressor for those with migraine is the unpredictability of when a migraine attack might occur. Having a plan in place (natural remedies, an abortive med, ice packs etc) can help reduce the stress about a possible attack, ultimately decreasing your attack frequency. Having a plan is key!

Treatment for vestibular migraines is overall similar to other migraine management, however Vestibular Rehab Therapy with a physical therapist can be helpful and neuromodulation devices (cepahly or gammacore for example) can be good options to consider when addressing vestibular migraine!

Contact info for Dr. Huma Sheikh:

Instagram: @headachesnyc

Website: Headachesnyc.com

Dr. Sheikh talks more about family planning, diet, and sleep in the premium content in Vestibular Group Fit. Found out more at this link: https://tvd.flywheelstaging.com/about-group/

Disclaimer:

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!

Visual Vestibular Integration: Why do busy environments make me dizzy?

Our body uses three main systems to know where we are in space and what needs to be done to be balanced and safe. Today’s focus is going to be on our eyes and inner ear working together with visual vestibular integration. Let’s talk about what this is, what happens when visual vestibular integration isn’t working, and what to do about it!

If you need a refresher on our body’s main systems for balance, click here to review our What is Balance article before reading on.

What is visual vestibular integration?

Visual vestibular integration is combining the information from our eyes and inner ear to carry out tasks to help with our balance. These two systems work closely together to help keep our vision steady when moving our body, head, or both at the same time. This is known as the vestibulo-ocular reflex (VOR).

The brain also uses visual and vestibular information to gather as much information about your environment and compares all this information to get as clear a picture as possible. This creates checks and balances to ensure that our brain knows what is going on and can respond correctly.

A good example of this is when you’re sitting in a parked car. The car next to you starts to back up, and you feel like you’re moving briefly. This is your eyes picking up the car backing up next to you and saying “hey we’re moving what are we going to do about it”. You quickly realize that you aren’t moving because your vestibular system kicks in and says “actually we aren’t moving, the eyes are seeing that other car move, we are SAFE”.

If you read the previous article What is Balance, you know there’s the proprioceptive system. We do use our proprioceptive system to compare sensory information with our eyes and inner ear- especially on uneven surfaces and to make sure any body movements are accurate and correct. This relationship is not the main focus of this article but it does exist! We’re focusing on the connection between the inner ear and eyes because of certain symptoms people experience when visual vestibular integration isn’t accurate, so keep reading on to learn more.

What happens if visual vestibular integration doesn’t work?

If the signal from our vestibular system isn’t sending or perceiving the correct information (BPPV, neuritis, VM etc), our brain starts to ignore what our vestibular system is saying and rely more on our visual system. Using only our eyes can result in busy environments making you feel dizzy or like you are moving when you really aren’t. The vestibular system isn’t being used in these situations to double check the information for our eyes. Things like busy areas like malls or restaurants, action scenes in movies, or first person video games can make your symptoms worse. Luckily, there are ways to work on reducing the reliance on your eyes and start using accurate vestibular information to feel better in busy environments.

How to promote visual vestibular integration.

Balance exercises that challenge vision help promote your vestibular and proprioceptive systems. With practice and gradual progression of these exercises, our brain starts to relearn how to listen to all 3 senses equally again. Consulting a trained and licensed vestibular therapist can help you safely progress these exercises and is strongly recommended. The goal is to start with sitting or standing balance exercises that make the visual and proprioceptive information hard to gather, so your brain has to rely on vestibular input to complete the exercise! This can be done in a variety of ways,a few ways a trained vestibular PT might accomplish this is:

Eyes closed
Eyes open with videos
Firm surface
Foam surface
Standing feet apart or feet together.

There are many ways to tailor exercise individually and safely. Consult a professional to evaluate your specific needs and assist you in the safe progression based on your needs!

Want to learn more about visual vestibular integration, and other vestibular tools to get back to your daily life? Found out more at this link: https://tvd.flywheelstaging.com/about-group/

Disclaimer:

Your hormones, dizziness and diet, with dietitian Susannah Juteau

Susannah is a registered dietician and headache nutritionist. Her focus is to address headache conditions like migraine and the use of diet to assist with lifestyle management and reduction of headaches or migraines! In group fit, Susannah sat down with Dr. Madison to discuss how food can impact hormones and how this can assist with migraines.

How can food impact hormones?

For a reminder on the many impacts of hormones on vestibular conditions, we have a blog post that reviews hormonal contributions to the vestibular system (click here) and how hormones change across the lifespan (click here).
Today the focus will be on estrogen and how diet can impact estrogen levels. Estrogen is an important hormone that can be a migraine trigger for some individuals 1,2,3. Rise and fall in estrogen levels throughout the female menstrual cycle can cause a flare up in headache, migraine or your vestibular condition. A change in estrogen levels is normal throughout this cycle, but diet can help avoid large increases in estrogen levels and sudden drops which can be beneficial to managing headache and migraine!1,2,3

Seed cycling is one way to use food and nutrition to assist with flare ups connected to your period. When Dr. Madison asked Susannah one thing that’s simple to try to help with estrogen levels, Susannah said eat more vegetables! Eating a plant based diet full of nutritious foods is a staple to health! We get so much dietary fiber, nutrients, micronutrients, and more from plants that cannot be found anywhere else in the world. Focus on eating a diverse number of foods throughout your whole life and each day for the best gut health! Susannah mentioned that these types of vegetables assist with breaking down excess estrogen and can help keep the fluctuation in estrogen levels in a more normal range to avoid big spikes and falls. This can help manage hormone related headaches.

What is the best Diet

There is no ONE diet or BEST option for dizziness and diet. Overall, avoiding overly processed foods and sticking to a whole foods diet is a good starting point while also reaching out to a registered dietician and nutritionist like Susannah Juteau for further guidance and education.

Dizziness and diet have a complex relationship between each other, and it’s important that we nourish our bodies with the right nutrients in order to get to a better place in our gut health, our brain health, and our vestibular health.

Keep in mind the benefits of a healthy diet for not only assisting with hormone fluctuations but giving your body the nutrients and fuel it needs for best function.

Vitamins and supplements can be helpful, but relying on only vitamins and supplements for nutrition can’t replace all the benefits from a healthy diet.

If you want more tips, check out what Susannah offers on her instagram sn services on her website!

Website: www.headachenutritionist.com/

Instagram: @headachenutritionist

If you’re interested in learning more about tests that could be helpful, other dietary tips to help with hormone and headache management, or catch the full interview with Susannah and a PDF of information, consider joining our vestibular community that includes dozens of premium content modules of information and resources and a great community to support you! Found out more at this link:

Click here

SD;, S. (n.d.). Sex hormones and headache. Revue neurologique. Retrieved April 21, 2022, from https://pubmed.ncbi.nlm.nih.gov/11139745/
World Migraine Summit. (2022). How Women’s Hormones Affect Migraine. Retrieved April 2022.
Northrup, Christiane. (2015, May 29). Migraines. Christiane Northrup, M.D. Retrieved April 21, 2022, from https://www.drnorthrup.com/migraines/

Resources

Disclaimer

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!

What is sleep and why do we need it?

Sleep is defined as an altered state of consciousness. Research is ongoing to learn the importance of sleep. What we know so far is that sleep is an important part of our everyday life to help with healing and repair. Sleep gives our brain a chance to reset and allow our body to repair. Lack of sleep has been linked to other health issues such as anxiety and depression (Kim et. al).

There are two main types of sleep, light sleep and deep sleep. Light sleep is when you’re able to wake up more easily and spring into action if needed as a protective mechanism. Deep sleep can be broken down into slow wave and REM (rapid eye movement). Slow wave sleep is a time for your physical body to heal and be refreshed for the next day of movement. Deep sleep happens in the late hours of the night and into the early morning which is why having a consistent bedtime to capture these hours is important for healing both body and brain!

What does sleep have to do with my vestibular system?

Our vestibular system is connected to sleep in a number of ways. Thirty percent of those with vestibular disorders have reported an abnormal amount of time asleep and disrupted sleep patterns (Albathi).

When getting ready for sleep, our brain is listening to our vestibular, somatosensory and visual systems to know we are lying flat and aren’t moving so our brain knows our body is safe and ready to sleep. Those with vestibular conditions can have a harder time with sleep because their brain has a harder time getting this message that it’s time to rest.

Another connection of the vestibular system and sleep is when sleep levels increase, vestibular signals decrease. This is why drowsiness is commonly felt when motion sickness or vestibular systems worsen, and why sleep can help you feel better. In those without vestibular conditions, poor sleep showed slower reaction times and increased motion sensitivity. If you do have a vestibular condition, it is vital to get good and restful sleep for proper vestibular function.

Sleep and its healing properties can be extra vital for vestibular rehabilitation therapy. During REM, new connections are being made and strengthened in our brains and are important in forming new, positive connections with movement to help move with reduced or zero vestibular symptoms! Sleep is important for rehab and should be a part of your treatment and recovery.

Lastly, vestibular migraine has been shown to have a connection with sleep. Having good and consistent sleep is something we have discussed before as an important part of raising the migraine threshold. People with migraine may need more sleep than those without to help with raising their migraines threshold and vestibular recovery each day to reduce migraine attacks (Albathi).

Tips for better sleep

Exercise regularly. Research shows that people who exercise regularly will have decreased risk of insomnia. This can be beneficial for anxiety, stress and general health too! (Banno)
Keep a consistent sleep schedule. Even on weekends and vacations! Choose your favorite 7-8 hours; your brain LOVES a routine and LOVES a habit. And, a brain also managing a vestibular disorder loves ‘boring’. This means that you need to go to sleep and get up around the same time every single day.
Sleep in a cool room. We need to drop our core body temperature by 2 degrees to fall asleep. Sleeping in a cool room, even if you’d like a big blanket, will help to optimize your sleep
Get enough Vitamin D and B Vitamins. Not enough of either of these can reduce your ability to sleep, and can increase attacks.
Try to avoid naps longer than 20 minutes. Napping longer than this in the day can make it harder to sleep at night.
Establish a relaxing bedtime routine that you enjoy. Turn off the TV, stretch or do yoga, listen to a meditation, or something else relaxing. Remember to turn off all screens during this time
If you don’t fall asleep within 30 minutes, get up out of bed. Get out of bed, and go to another room in your house. Sit on the couch, pull out a book or magazine, something analog is preferable and read for some time. DO not look at a screen, that will perpetuate the issue.

Other Resources

Dr. Stasha Gominac

Dr. Gominac spoke at the World Migraine Summit 2021. Dr. Gominac discusses the use of vitamins to help restore sleep quality and protect the body from migraines. Consider reaching out to learn more about her programming and consult your doctor if this would be right for you!

Louisa Nicola

Louisa Nicola is host of the podcast ‘The NeuroExperience Podcast’ and founder of NeuroAthletics. She has great FREE resources and content on her podcasts with interesting guests to listen to and learn from!

Want to learn more about sleep, the vestibular systems and ways to get better sleep? Find out more at this link: https://tvd.flywheelstaging.com/about-group/

Disclaimer:

Resources

Kim, Sung Kyun et al. “Relationship between sleep quality and dizziness.” PloS one vol. 13,3 e0192705. 7 Mar. 2018, doi:10.1371/journal.pone.0192705

Albathi, Monirah and Agrawal, Yuri. ‘Vestibular Vertigo Is Associated with Abnormal Sleep Duration’. 1 Jan. 2017 : 127 – 135.

Banno, Masahiro et al. “Exercise can improve sleep quality: a systematic review and meta-analysis.” PeerJ vol. 6 e5172. 11 Jul. 2018, doi:10.7717/peerj.5172

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.

Hormone levels change throughout the lifespan. Anecdotally, many of those with vestibular conditions appear to develop these conditions around these times of large hormonal changes. Let’s break down some of these milestones and how they relate to vestibular conditions.

Here is a quick breakdown of different time periods through a person’s life

Prepubescent: infancy through puberty. 1-15 years old

Reproductive age: after puberty, approx 15-40 years old

Perimenopause: “around menopause” time before menopause when inter-menstrual irregularities and changes begin.

Menopause: 12 months after final menstruation has occurred (1)

Prepuberty and Puberty & your Vestibular Disorder

One study has shown that in prepubescent males and females, the prevalence of migraine is equal at 4% occurrence. After puberty when a shift in hormones takes place and females have higher levels of estrogen, males with higher levels of testosterone, there becomes a dramatic change in migraine prevalence. After puberty, female prevalence in migraine is 18% and males is 6% (this is migraines in general and not vestibular migraines specifically). Part of what contributes to this change between males and females is attributed to the difference in estrogen levels. (2)

Pregnancy & Your Vestibular System

Typically, pregnancy has protective benefits from vestibular symptoms and migraines. The first trimester of pregnancy can be variable- some have worsening of migraines or new migraine symptoms such as an aura. Some experience migraines for the first time ever in the first trimester. In the second and third trimester there are higher estrogen levels which acts as a protection from migraines and most women typically experience improved symptoms. (3)

Talking to your doctor about supplements during and after pregnancy is important to keep you and your baby safe. Ask about B2, B6, folate, B12, vitamin D, magnesium, CoQ10, ginger, L-tryptophan and peppermint oil. (4)

Meniere’s disease may have a worsening of symptoms in the first trimester from fluid retention and reduced particles in the blood. This can impact how fluid is distributed at the semicircular canals and cause an attack. A diuretic or low salt diet may be recommended by your doctor to assist with reducing attacks during the first trimester. (5)

Post Partum & Your Vestibular System

Immediately after giving birth, estrogen levels drop. This can result in exacerbation of migraine or vestibular migraine symptoms. Another hormone that can be involved is prolactin which helps with milk production after giving birth. Prolactin is controlled by the hypothalamus in the brain. There are theories that hypothalamus involvement is linked to migraines. Not everyone feels a worsening of migraines when breastfeeding, 50% feel that breastfeeding has been protective against migraines. (3)

Other factors to consider are postpartum depression and new stresses of being a parent of a newborn that can make you migraine or vestibular symptoms worse. Look above in the pregnancy section to see what supplements to ask your doctor about. (6)

Perimenopause & Your Vestibular System

Perimenopause tends to be the time where people are noticing new or changing vestibular symptoms or conditions. Those who never had a vestibular migraine before will start having VM (people with and without a previous migraine history). (7) Some theories around migraine believe that estrogens’ impact on serotonin (a neurotransmitter responsible for pain and mood) can create a cascade leading to a migraine. Estrogen impacts serotonin, serotonin impacts the trigeminal nerve, trigeminal nerve has CGRP which has been shown to be involved with migraine (7). Perimenopause is a time where estrogen levels are more erratic which results in periods becoming further or closer together (and less predictable). This can be one factor contributing to the onset or worsening of vestibular migraine in perimenopause. Perimenopause also has more vasomotor symptoms (hot/cold flashes for example) which can impact symptoms. Risk of depression also increases at this time. This can have a widespread impact in other areas of your life, but can also play into worsening symptoms (8).

Menopause & Your Vestibular System

One full calendar year after one’s last period is considered menopause (1). Most with Meniere’s experience fewer attacks which can be theorized from fewer hormonal fluctuations (9). In this time of life, changes of BPPV increase and continue to increase as one ages. For migraines, there are fewer hormonal fluctuations but other contributing factors could continue to play a role in causing a migraine. It is important to continue to address these factors to optimize how you feel and gain control to manage your migraine (1).

Managing hormonal changes & Your Vestibular System

If HRT isn’t a great option for you, look at our previous article on Hormones and vestibular disorders to look at some other tips. Other things to keep in mind are:

Address contributing factors (ex: neck or back pain)
Exercise can assist with serotonin levels
Certain foods can be helpful (think whole food/plant based food. Less processed foods)

Want to learn more about testosterone, oxytocin, progesterone and Q&A from other vestibular warriors?

Click here to Learn More!

Disclaimer:

Resources:

World Migraine Summit. (2022). How Women’s Hormones Affect Migraine. Retrieved April 2022.
SD;, S. (n.d.). Sex hormones and headache. Revue neurologique. Retrieved April 21, 2022, from https://pubmed.ncbi.nlm.nih.gov/11139745/
Sances G, Granella F, Nappi RE, Fignon A, Ghiotto N, Polatti F, Nappi G. Course of migraine during pregnancy and postpartum: a prospective study. Cephalalgia. 2003 Apr;23(3):197-205. doi: 10.1046/j.1468-2982.2003.00480.x. PMID: 12662187.
Beh, Shin C . Victory Over Vestibular Migraine: The ACTION Plan for Healing & Getting Your Life Back (p. 233). Beh Center for Vestibular & Migraine Disorders, PLLC. Kindle Edition.
Andrews JC, Ator GA, Honrubia V. The Exacerbation of Symptoms in Meniere’s Disease During the Premenstrual Period. Arch Otolaryngol Head Neck Surg. 1992;118(1):74–78. doi:10.1001/archotol.1992.01880010078020
Beh, Shin C . Victory Over Vestibular Migraine: The ACTION Plan for Healing & Getting Your Life Back (p. 229). Beh Center for Vestibular & Migraine Disorders, PLLC. Kindle Edition.
Northrup, Christiane. (2015, May 29). Migraines. Christiane Northrup, M.D. Retrieved April 21, 2022, from https://www.drnorthrup.com/migraines/
Migraine World summit. (2021). Overcoming Monthly Menstrual Migraine. Migraine World Summit. Retrieved 2022, from https://migraineworldsummit.com/talk/overcoming-monthly-menstrual-migraine/.
NIH. (2016, April 25). Understanding how testosterone affects men. National Institutes of Health. Retrieved April 21, 2022, from https://www.nih.gov/newsevents/nih-research-matters/understanding-how-testosterone-affects-men