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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?

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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.

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

Hormones and Vestibular Conditions

Hormones are the chemical messengers for our body that travel through our bloodstream. They are in charge of so many of our bodily functions: hunger, emotions, growth and development, feeling ill etc. Research has shown a hormonal connection to the vestibular system and certain vestibular conditions. In this article we will look at estrogen’s and prolactin’s role in vestibular conditions. (1)

Estrogen is present in all humans but there are higher levels of estrogen in females. During childbearing years for females, estrogen levels change monthly throughout the menstrual cycle.

Estrogen levels drop 2 days before one’s period and right before ovulation; in between those drops there is a gradual rise in estrogen levels. The drop is estrogen during ovulation and before your period is when most people notice an increase in vestibular symptoms. (2)

Prolactin has over 300 roles but today we’re looking at its involvement with milk production and breastfeeding after childbirth. This hormone is controlled by the hypothalamus, and in some theories the hypothalamus plays a role in migraine. Based on the theories including the hypothalamus in migraine, prolactin could play a role in migraine in those who are breastfeeding. (3)

Meniere’s disease and Hormones

Common hormonal changes impacting Meniere’s disease are during the premenstrual phase of your period and pregnancy. Hormonal changes and fluid retention during these times can increase attacks. Fluid retention and hormonal changes can result in a change in fluid movement that can result in a Meniere’s attack. Research showed in one trial that those who had hormone therapy found some benefit in reducing the number of attacks. (4)

Acoustic neuroma and Hormones

Acoustic neuroma is a slow growing mass that impacts the vestibulocochlear nerve. This mass is typically benign and can cause imbalance, dizziness and hearing changes.

A study in mice showed increased growth of acoustic neuroma tissue. It appears that estrogen affects the pace of mass growth in acoustic neuroma. (5) Acoustic neuroma is also more common in women than in men, this may be in part due to higher estrogen levels in women, but more information and research is needed.

Vestibular migraine and Hormones

Migraine in general can be linked to hormonal fluctuations leading up to or at the start of one’s period (6,7). For vestibular migraine this may increase dizziness. The sudden drop in estrogen during menstruation and ovulation can cause an exacerbation of vestibular migraine. It’s been shown that migraineurs have a faster drop in estrogen than non migraineurs. (7,8). Another theory regarding migraine involves the relationship between estrogen and serotonin. Estrogen impacts serotonin, serotonin impacts the trigeminal nerve. The trigeminal nerve can cause migraines due to its release of CGRP. CGRP has been connect to migraine and the reduced ability to process CGRP, and anti-CGRP medicines were created to help treat migraines. (8)

Prolactin can also play a role in migraine. Both individuals with higher and lower levels of prolactin have been correlated with various types of migraines. Prolactin also has a connection to the trigeminal nerve and hypothalamus which have been theorized to have roles in migraines. (9). Prolactin has so many functions day to day so just a reminder that you don’t have to be breastfeeding for prolactin to have an influence on migraines. Breastfeeding is one of the many jobs prolactin is involved in, so if you’re breast feeding and notice changes, prolactin could be playing a role.

A side note: If you experience more headache symptoms with your migraine, research has shown addressing low testosterone (increase to higher levels within normal range) has been shown to reduce headache frequency. (10)

Managing hormonal changes

Hormone therapy is one way to address hormonal changes. This is a discussion to have with your doctor to see if this is a right fit for you. Hormone testing is generally not accurate because our hormone levels are always changing. Most hormone therapy involved dosing bioidentical hormones to help smooth out the fluctuations. This can be prescribed as a pill, patch, IUD or gel. (18/19). Some find hormone therapy helpful, others find that it makes symptoms worse, talk to your doctor about starting hormone therapy and give them updates on how your feeling so they can adjust your plan.

Other options to consider if hormone therapy isn’t for you are:

Triptans: talk to your doctor if triptans could work for you and for your doctor to create and monitor your plan.
Preventative medications: another great conversation for your doctor!

Talk to your doctor about preventative supplements
- Magnesium
- Riboflavin (b2)
- Coq10
- Vitamin D
- Omega 3s
GammaCore or Cefaly to assist with nerve stimulation for symptoms. (11)

Stay tuned for the breakdown of hormones throughout the different phases of life (puberty, pregnancy, post partum, peri/menopause) in our next article!

Do you want to learn more about how hormones can impact your vestibular condition?

Click here to Learn How to Manage Your Hormones & Vestibular Disorder

Disclaimer:

Resources

Kesserwani, H. (2021). Migraine triggers: An overview of the pharmacology, biochemistry, atmospherics, and their effects on Neural Networks. Cureus. https://doi.org/10.7759/cureus.14243
Bb Natural Health. (2018, October 11). Cravings during your cycle. BB Natural Health. Retrieved April 21, 2022, from https://www.bbnaturalhealth.co.za/blogs/articles/91631363-cravings-during-your-cycle
Tzabazis A, Kori S, Mechanic J, Miller J, Pascual C, Manering N, Carson D, Klukinov M, Spierings E, Jacobs D, Cuellar J, Frey WH 2nd, Hanson L, Angst M, Yeomans DC. Oxytocin and Migraine Headache. Headache. 2017 May;57 Suppl 2:64-75. doi: 10.1111/head.13082. PMID: 28485846.
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
Stidham KR, Roberson JB Jr. “Effects of Estrogen and Tamoxifen on Growth of Human Vestibular Schwannomas in the Nude Mouse.” Otolaryngology— Head and Neck Surgery, 120(2):262–264, 1999
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/
Gazerani, P. (2021, September 24). A link between migraine and prolactin … – future-science.com. future-science.com. Retrieved April 22, 2022, from https://www.future-science.com/doi/10.2144/fsoa-2021-0047
Watson, S. (2020, July 7). Low T and headaches: What’s the connection? Healthline. Retrieved April 21, 2022, from https://www.healthline.com/health/low-testosterone/headache
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.

Food is medicine – nutrition and vestibular migraine with Kelli Yates, RDN

Food and diet can impact how we feel, and can play an important factor when it comes to the management of certain vestibular conditions. Your doctor may recommend certain dietary guidelines based on your vestibular condition and other factors (medications, other health conditions etc).

For vestibular migraine, certain foods can provoke your symptoms or trigger a migraine depending on how “full” your migraine threshold is on a given day. (click here to learn more about threshold/bucket theory and some additional information on migraine diets). If you’re not sure where to start with changing your diet, a registered dietitian or nutritionist can be a great resource and guidance in exploring how food can be medicine.

Kelli Yates, RDN, LD, CLT is a private practice registered dietitian and specializes in migraine and gut health. She became interested in this area while pursuing her own answers to help manage her migraine beyond medication. Kelli has self guided programs, 1 on 1 help with her personally, and great information that she shares with us all on her instagram (@the.migraine.dietitian).

Kelli sat down with Dr. Madison to discuss how food can impact our health, especially those with migraines of all types.

Kelli notes how food can be medicine as both a preventative and active treatment. In general, food is best used as a long term preventative. For migraine, this long term management of symptoms with food involves learning what foods provoke symptoms or trigger a migraine and in what quantity. Some foods may need to be avoided altogether and others you may be able to enjoy in moderation, it really depends on the person. An elimination diet can help reduce common food triggers for migraine and then you reintroduce foods to determine if they affect you.

Food can sometimes have an immediate effect. Peppermint and ginger can help with acute nausea and initial symptoms. Food schedules can also have a more immediate change on how you feel. Regular meal times/not skipping meals, or healthy snacks throughout the day can be a small change that could impact how you feel.

Here are some tips Keilli shared with us regarding diet and migraine:

Reintroduce foods one at a time. There are many ways to introduce foods and a dietitian is a great resource to help tailor reintroduction to you!
Low histamine diets are a temporary solution. If a low histamine diet helps, further care is needed to get to the root cause.
Do what works best for you. Listen to your body on what feels good or bad. You know your body best. Keep that in mind before trying something that is suggested you try or you were told worked for someone else.

If you want to hear more from Kelli, follower her on instagram @the.migraine.dietitian or go to her website https://kelliyatesnutrition.com/

Kelli talks more about reintroducing foods, why low histamine diets are only temporary solutions, probiotics, gut health testing and anxiety around food in her talk with Dr. Madison.

Do you want to learn how to manage your vestibular disorder holistically, through diet and more?

Click here to Manage your Vestibular Disorder Better

Disclaimer:

Vestibular disorders and work

Vestibular symptoms can make working full or part time very difficult. In my experience a majority of people with vestibular disorders report being limited in their ability to get through work tasks with their current symptoms. Many either work more hours to get their tasks done, have an increase in symptoms or both. This is where work accommodations can help you get back to your daily routine while keeping your symptoms manageable.

Under the ADA (Americans with Disabilities Act) reasonable workplace accommodations are to be made for those with a disability. 1 According to the Job Accommodation Network, a person qualifies as someone with a disability if they have “a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment. “ 1 Based on this definition, your vestibular disorder qualifies you under the ADA to request changes at your job to get you back to work while managing your symptoms. If you’d like to learn more about the ADA, The ADA National Network provides a breakdown of the ADA. It discusses who qualifies, ideas of what is considered a reasonable accommodation, how to start the process, and additional resources and contact information for further questions. 2

Vestibular disorders have a wide range of symptoms which makes it important to tailor your workplace accommodations to what you specifically need. The Job Accommodations Network provides a few questions to help identify barriers currently at your job to help you prepare a thorough request to your employer. It also has some general accommodations to consider and help you brainstorm what will work best for you. Below are some tips to help you get back to work:

Blue light blocking glasses or screen covers (We like Avulux glasses because they’re backed by research!)
Small rest breaks throughout the day
Move your desk to a quiet area
Flexible scheduling to pace out more challenging tasks

If you have more questions about who to talk to, what to do if your job isn’t accommodating your requests, or switching jobs completely, all of this is covered with our premium content with Vestibular Group Fit.

If you would like to return to work and other functional activities, Vestibular Group Fit can help! Click below to find out how

Click here To Learn More!

Disclaimer:

Resources

Vertigo. (n.d.). Job Accommodations Network. Retrieved March 10, 2022, from https://askjan.org/disabilities/Vertigo.cfm
Northwest ADA Center. (n.d.). Reasonable Accommodations in the Workplace. ADA National Network. Retrieved March 10, 2022, from https://adata.org/factsheet/reasonable-accommodations-workplace

Having a vestibular disorder can make driving more difficult than for those without a vestibular disorder (1). As a clinician, driving is a common activity patients report having increased difficulty performing or are unable to do; severely impacting their independence and everyday activities. This is why driving is a big goal for my vestibular patients to get back to and such a big win when they do. Below is information about why driving is so challenging with a vestibular disorder along with a few tips to help manage being in a car and return to driving.

Why is Driving So Hard with a Vestibular Disorder?

Driving is difficult for those with a vestibular disorder because of a sensory mismatch between our vestibular, proprioceptive, and visual systems (you can learn more about how each of these systems relates to our balance and spatial awareness here). After an initial vestibular episode, our body is underutilizing vestibular information or receiving inaccurate vestibular information. When the information from our vestibular system doesn’t match up with the information from our other senses, symptoms occur (fogginess, lightheadedness, dizziness, rocking/swaying or feeling “off”).

With decreased input from the vestibular system, our bodies begin to rely more on our visual system to give us information. This makes driving challenging because of the increased use of our eyes. This makes busy environments challenging and overstimulating. If you’ve ever driven in the snow at night and you’ve accidentally turned on your brights; you’re suddenly overwhelmed with tiny snowflakes taking up your view and it’s very hard to see the road. That’s what it can feel like when you’re driving with a vestibular disorder.

When we rely on our eyes for a lot of our information, sometimes the way our brain processes our visual information changes too. What can happen is we focus too much on our central vision and ignore the information in the periphery. This can create more sensory mismatch and make it hard to determine where our body is in space. Think of a time you’re in a car while stopped (in a parking space or at an intersection) and you suddenly slam on your brake because you think you’re moving but it was actually the car next to you moving. This is what happens when we ignore our peripheral vision and use too much of our central vision.

Head turns is also a movement that can be difficult due to vestibular involvement. This is because our brain uses the information from our inner ear to help direct the direction and speed of our eyes. This is called the vestibular ocular reflex and can be affected by a vestibular disorder. This can make rapid and repetitive head movements needed for driving quite challenging. Luckily there are ways to help all of the reasons mentioned above to get you back to driving!

How to Make Driving with a Vestibular Disorder Easier

Be the driver if able and safe. Talk to your medical provider if you have questions or concerns about driving.

Look at the horizon (as a passenger). Looking further away from where the background is moving slower can help reduce symptoms.

Block out the busy noise. Use window covers to block bright light if you are light-sensitive and/or to block out busier environments. Make sure this does not block the view of the driver to drive safely.

Be prepared for any symptoms that might flare-up. Read more about motion sickness relief options here.

Work your way back to driving slowly in Vestibular Group Fit or Vestibular Rehabilitation Therapy

If you would like to return to driving and other functional activities, Vestibular Group Fit can help! Click here to find out how:

Click Here to Get the Driving Module

Disclaimer:

Resources:

Wei, E. X., & Agrawal, Y. (2017). Vestibular Dysfunction and Difficulty with Driving: Data from the 2001–2004 National Health and Nutrition Examination Surveys. Frontiers in Neurology, 8. https://doi.org/10.3389/fneur.2017.00557

The vestibular system is incredibly complex and in a perfect world it tells you, with impeccable accuracy, where you are in relationship to the rest of the world. It acts as a gyroscope – this means it measures angular velocity and maintains a perfect upright posture (plus, your vestibular system also measures linear velocity). It’s a pretty cool system, but when something goes wrong you could have a big problem.

Here’s what we are NOT focusing on today:

If you have a vestibular disorder you know that being upright can be a challenge, but why is it that a position of comfort, like lying down, is so problematic? I am not talking about Benign Paroxysmal Positional Vertigo (BPPV). BPPV is a mechanical issue where otoconia (ear crystals) fall from the otolith organs into the semicircular canals – this causes true room-spinning vertigo lasting from 15-60s with position changes. You can read more about it here. I also want to mention that I am not talking about MdDS. MdDS is a different condition secondary from disembarking from passive movement (like a bus, train, car, or train) and the symptoms does go away for weeks to months at a time. The treatment for that is the Dai Protocol and that’s NOT what we are talking about today. But you can read about it here.

Here’s what we are focusing on today:

The other kind of dizziness when you’re laying down, the kind where you feel like you’re on a boat when you’re in bed, happens for a few others reasons:

Your vestibular system doesn’t understand what position you’re in
Poor integration between your 3 balance systems
Your vestibular system is fatigued
Your bed is an uneven surface
You have anxiety about ‘causing’ BPPV (rest assured, you can’t trigger it by laying down)

Let’s Break These Down:

Your Vestibular System Doesn’t Understand what Position you’re In

Your vestibular system’s full time job is to determine where you are in space. It helps keep you upright (the Vestibulospinal Reflex), it detects head motion and moves your eyes accordingly (Vestibuloocular Reflex), it determines head position on the neck & neck movement (Vestibulocollic Reflex), and more! If your body doesn’t know exactly where you are in space, it’s trying to find the answer. The chronic unknowing-ness, along with anxiety that you could be doing something wrong tends to ramp up the feeling of rocking when you’re laying in bed. I can’t say its completely abnormal. because it’s happened to me a few times before and it is incredibly frustrating.

Your vestibular system has a lot of responsibility, but it also relies on other systems and programs in your body to help you interpret what’s going on in your body. This brings us to our next topic.

Poor Integration Between Your 3 Balance Systems

You have three balance systems in your body. Proprioception, the ability for you to feel your surroundings, vision, your ability see your surroundings, and vestibular, your ability to track acceleration and motion. All three of these systems need to integrate together in order for you to know where you are in space and decrease the rocking and swaying sensations. When these three systems don’t integrate, the rocking and swaying can start. Reintegrating them through movement, behavioral change, and vestibular rehabilitation, and vestibular education is the solution here.

Your Vestibular System is Fatigued

An injured vestibular system is working twice as hard and not getting 100% function. Working double time is never easy, especially if your vestibular system is just trying to keep you upright all day. Your body’s #1 function is to protect your brain, and to keep you from hitting your head. Doing anything else besides keeping you upright is hard for your brain and vestibular system. this causes vestibular fatigue, brain fog, and other irritating symptoms. This causes rocking and swaying at the end of the day because that system is just so exhausted it can’t function well anymore.

Your Bed is an Uneven Surface

Your bed will never not be uneven. You are going to have a soft bed – and no, buying a firmer mattress is not going to help. Your proprioception knows that your bed is uneven, and that can be irritating for the system as a whole. If your proprioception system isn’t sending a system that although you’re on an uneven surface you are still, your vestibular system becomes confused, perceives the wrong information, and then makes you feel like you’re moving.

You have anxiety about ‘causing’ BPPV

Having a history of BPPV can be scary, and it can be the reason you don’t lay down flat. The first thing that I want to make clear is that you are not going to ’cause’ BPPV by laying down. I know it’s scary, but if you get a BPPV attack it’s because the otoconia are already displaced and then you laid down afterward. However avoidance and sleeping at an upright position will cause dizziness over time, can set

So What if you Want to Fix the Swaying?

All the information you need is in the “Laying Flat” module of Vestibular Group Fit. By being a Vestibular Group Fit member you will learn all the education and exercises I teach to my Vestibular Rehabilitation Patients.

Click here to join us!

The holidays can be tough, and so can gifting! I don’t know about you, but in my family, we ask for exactly what we want so there’s no guesswork and everyone ends up happy campers. However, figuring out what would be a useful thing to receive can be difficult. So, I’ve put together this guide. Send it to your loved ones, or gift something to yourself! These ideas help decrease your trigger load and will help improve your quality of life with a vestibular disorder!

Avulux Glasses

I recently talked to the people at Avulux, and I am officially obsessed. They are the only brand of migraine glasses that has real third-party research backing them up! They filter out many wavelengths of light, not just blue light, that can be irritating for migraine and let through the green light that is soothing for migraine. They have research to show that wearing these glasses within an hour of a migraine can actually decrease the impact of your migraine and dull the pain without an abortive medication. They have options for prescription and non-prescription glasses, which is also a game-changer. Here’s a video on how it works. Code vertigodoc will get you $25 off your order!

Migraine Shields for Light Sensitivity

Migraine Shields are made by a vestibular migraine warrior for vestibular migraine warriors. They block the spectrum of blue light that people with migraine are sensitive to while letting some forms of blue light through – so things like sunlight and natural forms of light can get through, which is important for your circadian rhythm! You can use code vertigodoc20 for 20% off of your order!

Vitamins for Vestibular Dysfunction

Taking daily vitamins daily is essentially important for a vestibular disorder. My favorite vitamin company for people with vestibular dysfunction is Pure Encapsulations. They have very few additives and people do very well with them. However, if those are out of your price range, and you can tolerate Soybean oil (present in some vitamins), I’d recommend Nature Made Vitamins. If you or your loved one is in need of vitamins for Vestibular Migraine, that article can be found linked here. Vitamins and supplements are the first treatment for vestibular dysfunction very frequently, and research shows that they can really help decrease the symptoms – so it’s always worth a shot! But be sure to check in with your doctor first.

If you want to gift vitamins or supplements to a friend or family member, try subscribing to the vitamin on Amazon, that way you can get them a whole yea of vitamins and really take the stress out of ordering them monthly!

Vestibular Group Fit Subscription

Vestibular Group Fit is the only exercise and movement program based on your vestibular system. It intends to improve your physical strength, cardiovascular health, vestibular strength. VGF is the ONLY program created with your needs in mind. It accounts for dizziness, fitness levels, and difficult days where movement may feel impossible. It also includes premium content such as how to treat visual vertigo, navigating social situations, and more! You have the opportunity for 6 workouts per week, 3 of which are live classes. Come celebrate your body and movement with us!

The Dizzy Cook Cookbook

Alicia Wolf, the author of the Dizzy Cookbook, the absolute best when it comes to all things heal-your-headache diet. So many people with Vestibular Migraine respond incredibly well to altering their dietary needs. This book has more than the recipes you find on her blog, and she also has cute aprons and other products available! Check them out here.

Loops for Sound Sensitivity

If you, or your loved one, have sound sensitivity with migraine (or between attacks) Loops earplugs are your friends! They are specifically designed to decrease ambient noise, while letting you hear all other noises around you. You’ll be able to hear conversations around you, but the crowd noise will be blocked out – this is ideal for people who have hearing loss, hyperacusis, or difficulty paying attention to what their conversation partner is saying. Plus, they come in many colors, like silver, gold, black, roses gold, maroon, and more. And, the ear bud can be changed to meet the size of your ear, which is awesome!

Cefaly Device for Vestibular Migraine

The Cefaly device is very helpful for neuromodulation of migraine attacks. This has a preventative mode and an attack mode. You can read more about the Cefaly device, and other neuro-modulation devices here. The only one you can purchase over the counter is the Cefaly, and it’s a great one to try as they have a 90 day return period!

Allay Lamp

The Allay lamp is based on research that a specific wave of green light will help to decrease head pain and calm your brain during and between migraine attacks. If you are light-sensitive but need to get work done, the Allay Lamp is for you or your loved one! It emits a specific kind of green light that is calming – you can still get your work done without feeling the immense pain of bright lights during a migraine attack.

Norb Lightbulb

Norb lightbulbs are based on the same light technology that Allay Lamps and Avulux glasses use – green light is so calming! This light bulb can be placed into any lamp or light that holds a bulb. Itt will make the entire room green. They also have new research to show it helps with sleep!

Fatigue and exercise are a vicious cycle. This cycle often occurs when you do too much in one day, become exhausted, rest for a week, and exercise again. And the cycle repeats. Fatigue can happen for many reasons, many of which are due to a chronic illness. I understand that saying “you should just exercise more” to a person with chronic illness, and chronic fatigue is ableist, and I am not trying to preach that narrative. I will do my absolute best to explain how to exercise to prevent fatigue instead of triggering fatigue.

What is fatigue?

Fatigue is not being tired; it’s an entirely different feeling based on proper exhaustion. It is not because you haven’t slept enough, and no amount of coffee will make it better. Tired happens to everyone; we are tired after a hard workout, tired at the end of the day, and tired when we don’t sleep enough. Tired is not fatigue.
Fatigue is a constant and unrelenting form of exhaustion. Fatigue happens when our bodies cannot provide enough energy to function properly, let alone do our normal daily activities. This will ultimately lead to needing more rest than an average person and doing less movement overall. Our bodies love to move – we are meant to. But, if you can’t move as much as necessary, it leads to deconditioning.
Fatigue does not just come from being conditioned. Other chronic disorders, such as hypothyroidism/Hashimoto’s disease, chronic fatigue syndrome, myalgic encephalomyelitis, sleep apnea, POTS, kidney disease/organ failure, and other chronic illnesses can also be at the root cause of fatigue. However, most of these conditions, if there is too much rest involved, can lead to deconditioning, which is often the root of the issue.

What does Deconditioning Have to do With fatigue?

Deconditioning is a very complex physiological change in your body after a period of prolonged rest. This can happen as quickly as a week, but those losses are typically regained more easily. The deconditioning I am talking about occurs after months to years of not moving freely, walking, lifting, working out, or even consistently running errands. This will lead to a decrease in cardiovascular function, decreased muscle mass, and more.
Decreased muscle mass is what we are going to focus on here. A decrease in muscle mass can increase the risk of infection, decrease muscle strength & mass, increase the risk for comorbidities, increase the risk of death, and more. However, it would seem impossible to work out, move, and increase muscle mass with chronic fatigue, right? Well, not exactly. Strengthening, in many cases, is a primary key here.

How Strength Training Helps Fatigue

Fatigue stems from quite a few areas, as mentioned above. Still, for this article, we will talk about deconditioning as the source of fatigue, as deconditioning is a linchpin between all other conditions and fatigue. Your body can do a specific number of tasks each day, and your body needs the endurance to do all of those tasks. The strength of your muscles is a significant factor in fatigue. Your body needs to be strong enough cardiovascularly (heart and lungs) and musculoskeletally to provide your whole body the strength to get through a day with enough endurance not to run on empty and take energy from the next day by overdoing it.
Strength training works to combat fatigue by increasing your endurance. In this case, we are talking about muscle endurance, and although the science can get much more complex, it’s not necessary to understand how to combat it. You run around all day doing the same thing over and over, wondering why you become tired after a while. Becoming stronger, and working intentionally to strengthen the systems that are fatiguing helps improve your endurance. This is true for anything.
If you want to run a 5k race but can only run 1k right now, there’s no way you will run a 5k without training, right?
If you want to do a bicep curl with 15 pounds, but can only like 5 pounds right now, no amount of living your life the same way will help you get to that 15-pound mark.
This example can be said for anything, and it can be used to describe how strengthening your body will improve your ability to do your activities of daily living without extreme fatigue. You need to intentionally strengthen your system to be able to tolerate all of your activities.
Muscular strengthening programs, like Vestibular Group Fit, does this exactly. In this group, there is an opportunity for 6 days/week of workouts, which will strengthen your entire body. But cutting out 30-45 minutes of your day, a few times a week, you will be able to improve your overall endurance to be able to do more than you were previously. Your muscles will become stronger, your cardiovascular strength will improve, and you will be able to do more longer!

Energy Conservation for Fatigue

Energy conservation is planned rest and scheduled activity, which is helpful with chronic fatigue and chronic dizziness. Energy conservation is always helpful, with or without a fatigue dysfunction, but especially if you are becoming exhausted from activities that you used to not have any issue with. Energy conservation is the process of changing the environment or the task in order for it to match your energy levels and expenditure. Tactics like delegation, time management, task grouping, and interval rest are important to effective energy conservation.

Delegation

Asking for help where you need it is vital. People like to help, especially the people closest to us. Our loved ones are available to take on tasks when you don’t feel that you can. If you need extra groceries from the store, ask your partner to pick them up on the way home from work instead of making an extra trip out to get them. This helps conserve energy for when your whole family is home at the end of the day.

Time management

Manage your time in a scheduled way so you’re able to place high-energy tasks further apart from each other. When you have your day planned ahead of you, even if plans change, it will be easier to know what you can say yes and no to. If you’re having a day where you’ve managed to take a lot of time for yourself, and dinner plans pop up you will be able to say yes. It’s all about planning for what you need to do during the day, and not overdoing it into the next day.

Task Grouping

Grouping multiple tasks together that make sense together can be very helpful. Instead of making multiple trips out of the house daily, try making one trip for errands, but resting in between stores. You can take a break in your car or on a bench if you need, but you won’t have to drive both ways multiple times, saving you both time and energy.

Task simplification

As humans, we tend to overcomplicate things that should be simple. Try to buy precut vegetables, use grocery delivery services, sit to cook/clean/shower, and streamline your chores. The easier that all of these tasks are, the easier it will be for you to do more throughout the day! Really reflect on what you do day to day and try to implement simplification in at least 50% of them.

Interval Rest

Quit while you’re ahead. We tend to quit after we are running on empty and are feeling exhausted. In the photo below, the battery is slowly dying. Think of yourself like a battery that needs to be charged. Charging while you’re already partway charged is significantly more quickly than your phone’s battery dying and you needing to restart it. Rest before you absolutely need to charge. that means you may need a 15-minute nap or couch sit throughout the day. This is not something to be ashamed of; instead, be proud of yourself for listening to your body’s needs.

To decrease this fatigue overall, we need to strengthen your whole system. Taking time out of your day, every day, to schedule in simple strengthening exercises will build your battery so you will be able to be active longer without needing to stop due to fatigue.

Vestibular Group Fit has a Premium Content Module about fatigue. You will learn about prevention, energy conservation, treatment. And, the best part, is it can be completed from the comfort of your own home.

Click Here To Learn More

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The end of the year signals that we get to start getting excited to see all of our loved ones again! I know that since we have been stuck in a pandemic for SO long now, handling big events might need a little refresher. Holiday parties, cookie decorating get-togethers, and Thanksgiving day events are a lot to handle. This may be your first year managing the holidays with dizziness, or you may have years of experience. No matter where you are in your dizzy-journey, here are a few tips and tricks to help get you through the holiday season.

Check-in With Yourself

You know your body better than anyone. You determine where you go, what you do, who you see, and what you eat. If you want to go to a get-together with your friends, check in with yourself beforehand. How are you feeling? How long would you like to stay? Is there anything you need to do or bring to make your time there easier or more manageable? Setting ground rules and boundaries for yourself is incredibly important, and I absolutely recommend taking the time to reflect on your needs before you start getting together with others.

Bring Vestibular-Friendly-Foods

As a person with a vestibular disorder, it’s more than likely that you stick to some sort of diet. Even if it is not strict, you can never be too sure that there will be something you can eat where you are going. It’s really important to your vestibular system, especially with Vestibular Migraine or Meniere’s Disease, that your blood sugar stays constant, instead of having chronic fluctuations. Bring something you can keep in your bag to snack on, or bring a dish to the get-together you can share with everyone. That way, you can be sure there’s at least one thing you will be able to eat!

Stay Hydrated

Your brain is 75% water, and your vestibular system is largely water as well. Hydration is an absolute key to success when it comes to managing your vestibular disorder. If you are dehydrated, even without a vestibular disorder, you can become dizzy and feel off balance. So, if you do have a vestibular disorder it’s even more important to be sure you are getting enough water! Bring a water bottle with you and ask where you can fill it up. You won’t have to dirty a dish for your host, and you can be sure you’re getting enough to drink.

What to do About Alcohol

Avoiding alcohol with a vestibular disorder is frequently a given. However, you don’t have to avoid it 100% if your attacks are relatively under control. Some alcohols are more suitable for vestibular disorders than others, and I recommend giving it a try before you get to a party, but there are options for you! The alcohols that tend to be the least problematic are vodka, tequila, and dry white wine.

People who drink wine often have attacks due to the high levels of sulfites in the liquid. It’s almost impossible to find a wine with low enough levels for people with migraine and other inflammatory sensitivities, so PureWine has come up with a few solutions. These wine wands are easy to use. You just pop one in your glass of wine, wait a few minutes, and then you can drink. Be sure to follow the directions or you will not get the benefits. PureWine also has an option you can use as a pour spout as well to purify it upon pouring it from the bottle.

There's no need to suffer from wine intolerance when PureWine helps nightcaps go down more smoothly and easily. Order from PureWine here.

Photo from Newsweek https://www.newsweek.com/amplify/this-wine-wand-lets-you-enjoy-your-rose-without-hangover-heres-how

Be sure to drink AT LEAST 1 glass of water (8-10 oz) for every drink you have.

Stick to a Schedule

Sticking to a schedule is of the utmost importance when you have a migraine brain or any sort of dizziness. During the holidays especially, because there are so many events, it’s even more important. Try your best to plan which events you have been invited to, how many you actually want to participate in, how long you want to go to said event, and how much energy it may take up. Imagine yourself as a cup. Before chronic illness, you may have been a pint glass, but with a chronic illness, you’re more like a small water glass. With a chronic illness, our cups empty more easily than before chronic illness and stay empty without adequate rest. Continue to strengthen your body regularly, sleep consistently, fuel your body appropriately with food and water, and rest when you feel like you need it.

Even if you’re a glass-half-full kind of person, it’s more difficult to physically fill that glass than it used to be. Manage your time, sleep, exercise, and events wisely this season for more successful holiday parties.

Decrease External Stimuli & Pack Accordingly

Holiday lights & music combined with excited, loud humans can make for an overstimulating environment. There are quite a few things to help this

Migraine Shields: These glasses will help filter out the straining blue light that impacts your vestibular symptoms. They are made by a person with migraine, for migraineurs. I like them because they’re the lightest colored compared to other brands while filtering the blue light that affects you. This is different than wearing blue light glasses you get off of Amazon because it will only filter out the harmful blue light, rather than all of it. (code vertigodoc20 for 20% off your order!)
Earplugs: If you’re going to a particularly loud event, where maybe there are will be significant echoing, a live band, or many people, consider packing earplugs. These ones are designed to decrease the amount of noise, without distorting the actual sounds. So you’ll be able to hear people around you speak, but it will be less stimulating and easier to listen to.
Cane: A foldable cane, one that turns into a seat, or just a regular straight cane can help you to keep your balance inside a room where you may feel overstimulated.
Hat: Any hat you feel comfortable wearing, especially during outside events or ones with strobe-like lights inside will help to decrease the amount of stimulus entering your system.

Set yourself a stopping point

Always try to decide where you’re going to stop before you start. If your goal is to bake holiday cookies, run errands, and get some work done in one day, that’s a great goal. But, if halfway through you’re feeling like you might be too exhausted to do so, quit while you’re ahead. It’s so much easier to fill your proverbial cup when it isn’t running on empty than it is to fill the cup if you’ve drained it and taken extra energy. I

Have you ever noticed yourself getting into this pattern? After a relaxing weekend, Monday comes around and you run errands like you are the queen of the world and can do anything. Then, on Tuesday you’re so exhausted you can barely get out of bed – so you rest. Then, on Wednesday you feel pretty good, so you get as much done as you can, and Thursday you’re so exhausted you can hardly make it to the bathroom or kitchen? This is a cycle that happens because there is not enough energy conservation going on. Expending all of your energy and then some on Monday makes it so you can’t do anything on Tuesday. This is not a good use of your time. Instead, try doing half of Monday’s activities on Monday and half of them on Tuesday. I would be willing to bet you’ll spend less time in bed, more time doing the things you love, and actually get more done throughout your week overall.

Following these tips will help you get to more events, decrease the amount of recovery you will need to make, and improve your overall quality of life. Never be afraid to excuse yourself from the party when you need to, and conserve your energy for later when you can!

Due to the complexity of migraine, and vestibular migraine, finding a treatment that works for you can seem impossible. However, with so much new migraine research, there is more evidence for new treatments constantly coming out. This is great, but can be hard to keep up with! One of the latest and greatest treatments for migraine are neuromodulation devices. That’s just a fancy word for electrical stimulation machines used to moderate headache and migraine attacks. The following devices can be either be used as treatments for preventative care, acute attacks, or both! Some have more research than others, and it’s not for everyone, however, anything that we can do to avoid migraine overuse headache and prevent migraine without pharmaceuticals is a win in my book!

Cefaly for Vestibular Migraine

Cefaly is by far the most popular new migraine-neuromodulation device I’ve seen recently. Patients love it, people all over Instagram love it, it gets all-around good reviews. I like it for a few reasons. The first is that they give a 90-day money-back guarantee. If you have migraine, you know by now that you need 90 days to determine if something work for you or not, and Cefaly provides that experience, because if it doesn’t work for you, you can send it back free of charge. Additionally, the first week is free, and it can be on a payment plan. Next, you don’t need a prescription. You can literally buy ti from Amazon and it will ship right to your door for a one-time charge. You do need to get new electrodes once in a while, but you can decrease the number you use by following the directions on the inside of the box to prepare your forehead correctly. The downside? there aren’t many, however, you will look like you belong in Star Trek or like you’re some sort of alien for an hour every day. It does prevent you from going out, unless you wear a big hat, or just don’t care that people might give you a funny look. Additionally, some people just don’t like the sensation, and therefore won’t use it.

The preventative mode is to be worn daily for 20 minutes, and an acute treatment is 60 minutes. You simply place it on your forehead, turn it on, and you’re good to go! You can even fall asleep with it on! In my opinion, it’s worth a shot!

eNeura: sTMS (Single-Pulse Transcutaneous Magnetic Stimulation) For Migraine

sTMS uses magnetic wave fields to pulse through your brain and soft tissue into your head to decrease the frequency of Migraine attacks. sTMS has been used for years, but the eNeura device is one of the first devices that can be used from home. You simply place it behind your head at the base of your neck and press a button to direct an impulse into your brain to prevent and treat migraine attacks. You will need to have a doctor prescribe it to you, so click here to find a doctor in your area who is familiar with the device and can see if it’s right for you.

Nerivio for Vestibular Migraine

Nerivio is used as a peripheral nerve stimulator in your arm to ‘confuse’ nerves in your brain to distract the pain from migraine. The message from your arm is sent to your brainstem and inhibits the pain signals from your brain stem that are causing the painful migraine. According to their research found on their homepage, 74% of people found it at least moderately helpful in relieving migraine pain. Additionally, it has an app that helps to track your migraine frequency and control the stimulation from your arm. You can wear it out, as it is on your arm instead of your forehead, and it will still be discrete. This one can be covered by your insurance, so if you’re looking for something that’s important to you, this may be a good fit!

GammaCore for Vestibular Migraine

GammaCore stimulates the Vagus nerve, which is the long nerve that wanders through your whole body. It affects your brain stem, heart, gastrointestinal tract, and more. GammaCore device is to be pressed against your neck, right next to where you can feel your pulse, for a specific duration of time. The biggest con to GammaCore is its price. The cost of GammaCore is about $200 every three months. This may seems expensive, however for some people it can reduce the number of other medications and hospital visits they may need to pay for. This would more than make up the difference. If it works for you it could absolutely be worth it! You do need a prescription to receive it, so ask your doctor!