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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!

 

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.
woman with brown hair laying across a white bed, wearing white long sleeve top and blue shorts, looking exhausted.

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.

Woman standing outside, lights behind her blurry. Leaning against window reflecting her red hair.

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.
an 8oz water glass filled halfway on a white background with grey shadows

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

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!

 

 

Magnesium is an incredibly important supplement in our bodies, especially if we have migraine. Many studies have found that taking daily magnesium can help reduce migraine attack frequency and intensity. Typically the dose is 400-500mg/day for prevention, and then more for an acute dose if you’re trying to stave off an attack.

Types of Magnesium for Migraine

Magnesium Oxide

Magnesium oxide is the most common form of magnesium found in most stores, and if you pick up most drug store magnesium, it will likely be oxide. This is an affordable option and it’s in Class A of supplements, meaning it’s safe during pregnancy.

Magnesium Glycinate

Magnesium glycinate is the slightly less common form of magnesium, however its still easily accessible and does not cause the stomach upset that oxide does!

Magnesium Threonate

AKA CogniMag is something that many in the Vestibular Migraine community swear by for grain fog! IT’s a slightly different make up of magnesium and helps with improving cognition.

Magnesium in Foods

Many common foods are high in magnesium, and if you’d rather just try to eat enough throughout your day, you are welcome to try. The most common foods with high magnesium are beans/legumes, nuts and seeds, fiber-rich whole grains, dairy products, and many leafy greens. Although it’s entirely possible to get enough magnesium in your diet this way, it’s unlikely enough for a person with vestibular migraine, as a person with VM is typically low in magnesium, even if they eat a well-rounded diet.

Magnesium Spray

Magnesium spray is a topical form of magnesium that can help get magnesium into your bloodstream, without ingesting it orally. Because so many people are sensitive to magnesium in their gastrointestinal system, it’s not always an option to take it orally, even if you want to. A great place to start, other than your diet, are topical options! 4 sprays of this, on your skin, provides 66mg of magnesium! Although it’s a ways to get up to 400, it’s an excellent place to start!

Magnesium Lotion

Magnesium lotion, similarly to spray, is another topical option for you. This way, you won’t have gastrointestinal upset, but will still be able to increase the amount of magnesium your bloodstream absorbs. Additionally, it is a great way to practice self-massage on your neck. Take some of this cream, dab it on your neck, and rub your neck and shoulders for a neck-pain-relieving massage.

Magnesium Bath Soak

Sometimes when you are having a high pain migraine day, there’s nothing better than a warm bath. Pop this magnesium bath and foot soak in a bath of warm water and relax!

Magnesium Roller

The last option for non-oral magnesium is a roller. You can roll this anywhere on your body, it can sometimes help with sleep when put on your temples, or head pain relief!

Receiving a new diagnosis, one that you understand you have to live with forever, is jarring news; news that you likely never thought you were going to get. Accepting that you are now living with a chronic illness is not something easy to do.

As you probably know by now, I treat vestibular disorders but I do not have a vestibular disorder. However, I do want you to know that I write this post from a place of learning acceptance as well. Although I am not dizzy, I do have a chronic illness, Hashimoto’s Disease. It is a fairly common condition that affects your thyroid gland, and, similarly to Vestibular Migraine, affects 1-2% of the population annually. Learning to cope with a chronic illness is a process – it is not one that happens overnight, sometimes it can take years.

For instance, it can be really difficult to distinguish between life fatigue and fatigue that happens because of your diagnosis. It can be hard to learn your food triggers, because it may be something you’ve been eating your entire life and haven’t thought twice about it. And, largely, it can be hard to make a change when you’re so used to living with something that may have been left untreated for a long time. Accepting that you have a diagnosis is the first step in many senses, especially when it comes to living with a vestibular disorder.

Receiving an Accurate Vestibular Diagnosis

Vestibular specialists are hard to come by and when you finally find one, it’s likely that you have seen many other practitioners beforehand that have told you that you’re ‘totally normal’ or that ‘it’s all anxiety.’ The most common vestibular diagnoses are Benign Paroxysmal Positional Vertigo, Vestibular Neuritis, Vestibular Migraine, and Meniere’s Disease. There are many others, but they’re much less common.

Remember that vertigo is not a diagnosis, it’s a symptom. So, if you’re receiving the diagnosis of vertigo from your provider, either ask for another diagnosis or find a different provider.

When you receive a diagnosis, read up on it to make sure you fit the profile. For example, if you receive the diagnosis of BPPV, but your vertigo isn’t positional, try to seek another diagnosis. If your diagnosis does seem like you, congratulations on finding out the WHY of it all, even though it means you have to now deal with this new thing, it does not define you and it means you can start working to manage your symptoms.

Pink lettering with a black border reading "your diagnosis does not define you"

Learning about your diagnosis

Every vestibular disorder is different. There are different symptoms, protocols, dietary needs, and lifestyle changes that are required for each one. Luckily, there has never been more research on vestibular disorders and their needs than there is right now. A great starting point for learning about your diagnosis is right here on this website. Under the “Dizziness” tab you can find the name of most vestibular diagnoses and definitions, treatments, and more. Before you make any changes, it’s best to learn what will actually help.

Because no two people are the same, it may be ineffective to ask others who have the same diagnosis and copy them exactly. Some people may be gluten sensitivity, while others are not. It’s important to keep in mind that your vestibular diagnosis is your own and that although others may be similar, no one else has the same treatment plan as you do.

How to Best Use Support Groups

Support groups can be the best and the worst tool at the same time. It’s vital to find community, relate to others, and ask for advice from others who know, and for that, I absolutely love a good support group. However, spending too much time in a support group, especially one where things may not be too positive, can be really frustrating. Know when you need to take a step back from the group if it feels like it’s becoming overwhelming or negatively affecting your psyche. You are more than your diagnosis, and although it’s important for you to have a community around you, it’s equally important that you are able to focus on non-vestibular aspects of your life.

many people with brightly colored sweaters, with their arms in the center to begin a teamwork cheer.

Asking for Help (& Accepting It!)

You are not a burden on anyone. When you receive a diagnosis, your mind, body, and soul will go through many changes. You may not be able to do as much as you were able to, and accepting that new reality, having to do less throughout your day, and you may need to ask for help. As humans, we want to be as independent as well can, and do everything by ourselves – that starts when we are about 2 years old and never really stops. Asking for someone else to go out of their way to do you a favor, or to take on more than their normal load can be difficult. However, I’d like you to think of this backward.

If your best friend, neighbor, partner, child, or family member got sick or was going through something new and difficult, what would your initial thought be? Take a second and think about that.

I’m willing to bet the first thought that came to your mind was that you would want to help, right?

As much as we want to be independent, we also want to help. We are not as individual as we want to believe that we are. The “it takes a village” mentality is very real, and even when it’s hardest to admit, we do need help and people LOVE to help. If you find that by the end of the day you’re absolutely exhausted, you cannot manage to do anymore, but you still need to make dinner, ask for help then – but only the first time. I say this not because you shouldn’t ask for help making dinner, but because you should ask for help before you think you need the assistance.

We cannot give from an empty glass. You get one full glass a day, and prior to chronic illness, it’s likely that your cup was much bigger than it is now. Everything can take from your cup, doing laundry, walking the dog, getting your kids ready for school, brushing your teeth, eating, working out, and more. Every single thing you do takes energy. What things can you ask for help with? Can someone else walk the dog and make breakfast? Can you meal prep one meal so it makes it easier for you during the day?

Try making a list of all the little things you do throughout the day. Eating, cooking, laundry, dishes, and other small tasks – ask for help with those throughout the day so you’re able to make it to bedtime. Quit while you’re ahead, and your body will thank you for it later.

When you have a new diagnosis, managing the news, your new routine and your body’s needs might be enough to run your cup out of energy, however, there are ways to create a bigger cup, over time.

Remember, other people like to help. Good friends want to be there for you. Your partner can pick up some extra slack.

Setting Boundaries

It seems like the last few years everyone has really started to talk about boundaries, what they are, why they’re important, and how to ask for one. And, whoever these people are who created this term, are right – boundaries are really important. They’re important with family, romantic relationships, friendships, pets, and with yourself. A boundary is a limit that you set for yourself within a relationship. A person who has healthy boundaries is able to delve into intimate relationships and new experiences when they want to but also knows themselves well enough to set a limit for when they want to say no.

I want you to consider your own boundaries. Do you have them within your friendships or with family members? Do you have boundaries set when it comes to experiences, like you would never go skydiving? Are you able to open yourself up to others to ask for help when you need it? Do other people in your life have healthy boundaries? If you are sure you have healthy boundaries, that’s great! You are able to say no to a friend or family member if they ask you to go to a crowded gala where you are not comfortable, for example.

However, if you find yourself thinking that you may not have boundaries for yourself, try and think of a few that may help you. These do not have to be perfect or concrete the first time. These can fluctuate over time, and that is okay and normal. Start small, and try to be consistent. Boundaries can become habitual if they are repeated many times.

For more information on setting better boundaries, read this article. 

Green landscape with grass and trees. Old brown fence with a gate depicting a property line.

Changing What You Can Control

When you ask for help and set a few boundaries, you have made an active change – that is excellent. You can only control yourself. Your actions, your emotions, your choices. It’s important to remember this because other people may be at the source of your symptoms, but you can choose who to be around, within reason. Choose yourself first.

If you notice that really big box stores are a trigger for your symptoms, you know you cannot control the fluorescent lighting and tall aisles. However, you can choose to wear a hat, Migraine Shields, and earplugs. You can also ask if someone else can go to the store for you, or use a store’s storefront pick-up or delivery options. Small changes in these actions will both use less of your cup and simultaneously relieve the stress of another errand that may make you increasingly symptomatic.

Focus on what you can do, instead of what you cannot control.

Although you cannot be in control of others, you can control you. If large crowded areas where people are darting across one another are problematic, avoid the mall during peak hours. Talk to your family about screaming and yelling in the house – little kids may seem like they don’t understand, but they do listen, and most of them want to be treated like an adult. Talk to them individually, or as a family, and share with them what’s going on with you, and why their parent needs a little extra help or quiet time sometimes.

Girl reading a book with a cup of coffee. She has a green top, and pale skin. This photo is shot from the sky looking down, you cann see her torso and legs. She's sitting on her bed.

Accepting What is Out of Your Control

Not everything is in your control, we learn this from a young age. As much as we may enjoy micromanaging and trying to get everyone on our page, it’s just impossible. There is always going to be crazy carpet at hotels and in airports, airplanes are going to his turbulence, and the car in front of you may unexpectedly slam on their breaks. All of these may be triggers for you. Remember to stay calm, and breathe through the moment. Moments like these are always going to happen, and stressing out about what might make you dizzy or otherwise symptomatic will bring on your symptoms more than the event itself. Being stressed out can cause dizziness, and increasing that anxiety can only make things worse.

Here are a few tips to help you get through moments of chaos

 

 

Vestibular Migraine, as I’m sure you know by now, can be incredibly challenging to manage. Between weather changes, hormone changes, food triggers, and decreasing your caffeine intake, ‘a challenge’ doesn’t even begin to describe it. There’s a new study that I wanted to bring your attention towards, Dietary alteration of n-3 and n-6 fatty acids for headache reduction in adults with migraine: randomized controlled trial. 

This article is interesting because instead of taking another thing out of your diet, it talks about something you can and should eat more of – finally!

What Food Group is Great for Vestibular Migraine?

This new study from the British Medical Journal shows that increasing Omega-3 Fatty acids, and without decreasing Omega-6’s can help decrease migraine pain, days, attacks, and other migraine-related symptoms.

The research shows that altering Omega-63s without changing Omega-6’s can decrease pain severity and frequency of attacks. However, the research did not find that there was a significant difference in quality of life.

What’s the Science between Omega-3’s and (Vestibular) Migraine?

Vestibular Migraine occurs due to a complex cascade of events that begins in the brain stem and trigeminal nerve, impacts the trigeminocervical complex, and then impacts the vestibular system. This cascade of events is what causes both pain (trigeminal nerve) and dizziness (vestibular nerve) in those with vestibular migraine. Omega-3’s are protective against that response.

As human beings, we are great at many things, however, synthesizing our own Omega-3 and 6’s is not one of them. Therefore, we can alter the number of fatty acids we have at any given time with our diet and/or supplements. And, it just so happens that these fatty acids are essential to the migraine cascade – in fact, they have a big role in pain regulation.

The nerve endings of the trigeminal nerve (the one that causes pain in migraine) are regulated by these same fatty acids, called lipid mediators. These mediators and together known as oxylipin receptors, and they’re enriched at the end of the trigeminal nerves. They regular sensitization and the release of the headache-related neuropeptide calcitonin gene-related peptide (1). This fact implies that there is a link between omega-6 & 3 fatty acids and headache etiology.

The oxylipins that come from Omega-6’s have been found to “sensitize the trigeminal nerve endings, and evoke behavioral pain responses;” this means Omega-6’s can increase pain severity and migraine frequency (1). However, the oxylipins that are derived from Omega-3’s are found to have antinociceptive properties, meaning that they reduce pain (1).

Where do I Find Omega-6’s, and Should they be Avoided?

Omega-6, the kind of fatty acid that is found mostly in the typical American diet, in fact, there is research to show that most people who eat a Western diet eat significantly more Omega-6s than Omega-3’s. Omega-6’s do play a role in our body’s function, so you should not completely get rid of this kind of fat. However, because we eat so much Omega-6, and want to try to fit in more Omega-3, it’s important to know where they come from.

Where Do I Find Omega-3’s?

Omega 3’s are to kind of fatty acids we don’t get enough of in the Standard American Diet. It’si’mportant we get more of these than Omega-6’s so we can desensitize the trigeminal nerve, decrease pain severity, and decrease pain days overall. Although it may be easier for you to take them as a supplement, it is better to get them in your food, and more affordable. However, if you do not like any of these foods, it is typically recommended to get them in supplement form (aka Fish oil). Ask your doctor before you change or start a new supplement.

 

Source:

Ramsden, C. E., Zamora, D., Faurot, K. R., MacIntosh, B., Horowitz, M., Keyes, G. S., Yuan, Z.-X., Miller, V., Lynch, C., Honvoh, G., Park, J., Levy, R., Domenichiello, A. F., Johnston, A., Majchrzak-Hong, S., Hibbeln, J. R., Barrow, D. A., Loewke, J., Davis, J. M., … Mann, J. D. (2021, July 1). Dietary alteration of N-3 and N-6 fatty acids for headache reduction in adults with migraine: Randomized controlled trial. The BMJ. Retrieved October 5, 2021, from https://www.bmj.com/content/374/bmj.n1448.