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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

  1. 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)
  2. 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.
  3. 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 
  4. Get enough Vitamin D and B Vitamins. Not enough of either of these can reduce your ability to sleep, and can increase attacks. 
  5. Try to avoid naps longer than 20 minutes. Napping longer than this in the day can make it harder to sleep at night. 
  6. 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
  7. 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:

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

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.

  1. Am I going somewhere new or familiar?
  2. Is my destination vestibular-friendly?
  3. Am I traveling alone or with a trusted person?
  4. What do I need to talk to my doctor about?
  5. What activities am I going to do when I get there?
  6. How can my vestibular physical therapist help me prepare for this trip?
  7. What can I pack to help me manage my symptoms?
  8. What’s my travel plan when I arrive?
  9. What mode of transportation am I taking?
  10. 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?

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:

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

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

Tips for plane travel

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!

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

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:

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


Click here to Learn More!

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:

  1. World Migraine Summit. (2022). How Women’s Hormones Affect Migraine. Retrieved April 2022.
  2. SD;, S. (n.d.). Sex hormones and headache. Revue neurologique. Retrieved April 21, 2022, from https://pubmed.ncbi.nlm.nih.gov/11139745/
  3. 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.
  4. 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.
  5. 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
  6. 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.
  7. Northrup, Christiane. (2015, May 29). Migraines. Christiane Northrup, M.D. Retrieved April 21, 2022, from https://www.drnorthrup.com/migraines/
  8. Migraine World summit. (2021). Overcoming Monthly Menstrual Migraine. Migraine World Summit. Retrieved 2022, from https://migraineworldsummit.com/talk/overcoming-monthly-menstrual-migraine/.
  9.  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:

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:

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

  1. 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
  2.  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
  3. 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.
  4. 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
  5. 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
  6. SD;, S. (n.d.). Sex hormones and headache. Revue neurologique. Retrieved April 21, 2022, from https://pubmed.ncbi.nlm.nih.gov/11139745/
  7. World Migraine Summit. (2022). How Women’s Hormones Affect Migraine. Retrieved April 2022.
  8. Northrup, Christiane. (2015, May 29). Migraines. Christiane Northrup, M.D. Retrieved April 21, 2022, from https://www.drnorthrup.com/migraines/
  9. 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
  10. 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
  11. 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:

  1. 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!
  2. Low histamine diets are a temporary solution. If a low histamine diet helps, further care is needed to get to the root cause.
  3. 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:

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.

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:

  1. Blue light blocking glasses or screen covers (We like Avulux glasses because they’re backed by research!)
  2. Small rest breaks throughout the day
  3. Move your desk to a quiet area
  4. 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:

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

  1. Vertigo. (n.d.). Job Accommodations Network. Retrieved March 10, 2022, from https://askjan.org/disabilities/Vertigo.cfm
  2. 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

  1.       Be the driver if able and safe. Talk to your medical provider if you have questions or concerns about driving.
  1.       Look at the horizon (as a passenger). Looking further away from where the background is moving slower can help reduce symptoms.
  1.       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
  1.       Be prepared for any symptoms that might flare-up. Read more about motion sickness relief options here.
  1.     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:

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:

  1. 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:

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!