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Conquer vestibular migraine: a beginners guide

Here is a beginners guide to vestibular migraine. We’ll cover the difference between migraine, vestibular migraine, management tips and tricks, and when to start vestibular rehabilitation (VRT).

What is migraine? How is vestibular migraine different?

In general, migraine is a neurological disorder and has various symptoms that can be present. Here is a list of some common symptoms associated with migraine:

Migraines act differently with each person. A common misconception is that a migraine is only a bad headache, or if you know someone with migraines and their symptoms are different than what you experience you think “oh well I don’t have migraines because they’re nothing like my friends”. If it’s impacting your life, it’s worth talking to a medical provider about!

Vestibular migraine

Vestibular migraine accounts for 3% of all migraines. This subtype of migraine has specific symptoms relating to the vestibular system (vertigo, imbalance, dizziness, brain fog, feeling “off”, lightheadedness etc).

The International Classification of Headache Disorders criteria for vestibular migraine are:

    1. Headache with at least 2 of the following characteristics
    2. One-sided location, pulsating quality, moderate or severe pain intensity; photophobia or phonophobia
    3. Visual aura

click here for the research article that outlines this criteria.

The big thing to remember here is that not all vestibular migraines have head pain/headaches. Headache can be present, as well as the other symptoms on the list above in addition to vestibular symptoms.

Phases of migraine

The 5 phases are:

When to start Vestibular Rehabiliation (VRT)

VRT is beneficial in addressing residual symptoms after migraine attacks, or the interictal symptoms experienced in day to day life. VRT is most effective when attacks are mostly under control. If you’re having multiple attacks in a month, or you’re having a hard time getting symptoms under control, VRT may not be appropriate at that time. A couple of sessions may be helpful for education to try various methods to get symptoms under control, or addressing neck pain through gentle stretching, manual work, postural and ergonomic education).

VRT is most beneficial when your migraine is under control. Using habituation principles to improve interictal symptoms is best done when your vestibular migraine is under control. If your migraine and symptoms aren’t well managed, trying to do VRT is like throwing gasoline on an already raging fire and hoping it burns out.  This is why VRT can make you feel worse. It’s important to have a therapist familiar with vestibular disorders and vestibular migraine to guide and dose your VRT appropriately.

What should I do when I have a vestibular migraine attack

If you begin to feel an attack coming on, you want to initiate your plan as soon as possible to try to stop th eattack or minimze the severity or time of symptoms. This may look like:

Vestibular migraine management

There’s a lot of great content on tis website for vesitbular migraine, I tried to include most of it here but might have missed some. Vestibular Group Fit is a great place to find all this information presented to you in one spot with excellent resources, with a community of others to provide their own experience, advice and guidance for symptom management, lifestyle changes, and support with movement.

Disclaimer

Want to learn more about vestibular migraine management  and be a part of a supportive community to get back to your daily life?  Find out more at this link: https://tvd.flywheelstaging.com/about-group/

Disclaimer:

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

3 ways Somatic Therapy can help dizziness

Learn how somatic therapy can help dizziness with psychotherapist Kate Schwab, LCSW. We’ll cover what somatic therapy is, the benefits, and tools to get started today.

Kate Schwab, LCSW is a licensed clinical social worker and psychotherapist. In vestibular group fit, Dr. Madison and Kate talk about how somatic therapy can help dizziness and tools that are helpful in supporting your body.

What is Somatic Therapy

Somatic therapy combines psychology, neuroscience, ethology, physiology, indigenous healing practices, and medical biophysics. Guidance of somatic therapists assist you in learning what your body needs to feel supported.

3 parts of somatic therapy involve:

  1. Nervous system activation and overwhelm
  2. Pacing
  3. Support tools

We’ll take a look at each of these parts to learn how somatic therapy can help dizziness. More information and a recorded interview with Madison and Kate can accessed with a premium account.

How is Somatic Therapy different than Acceptance and Commitment Therapy (ACT) or Cognitive Behavioral Therapy (CBT)?

ACT/CBT are talk therapies type and focus on behavior. Both are symptom management focus. ACT brings in more mindfulness work: what are your behaviors and beliefs and changing those. With somatic therapy, it’s less symptom oriented and more of ‘what’s happening for you internally?’. We are looking at WHY those symptoms are there and deeper work. These areas cover different parts, so if you’ve had ACT or CBT therapy, you could benefit from somatic therapy. Keep reading to learn how somatic therapy can help with dizziness in its unique way.

Who could benefit from Somatic Therapy?

Most people can benefit from this work, and there are many reasons we experience trauma responses. Chronic illness can be traumatic and so in general somatic work can be really useful!

Nervous System Activation and Overwhelm

When first experiencing pain or dizziness, we begin to try everything and anything to make it go away. This urgency can lead to desperation, feeling overwhelmed and hyper vigilant of what we’re experiencing. This heightened state ramps up our sympathetic nervous system- the “fight flight or freeze”. This is not a state we are meant to be in for long periods of time,and normally kicks in when there is an external threat. When the threat is external, like a sudden loud noise or dark looming figure, this is extremely helpful to get us out of that area and to safety. In the case of dizziness, the perceived threat is internal, so how do we get to safety? This is where somatic therapy can help.

This is so so common in dizziness, check out this article on the dizzy anxious cycle and Dr. Emily Kostelnik with Rooted Behavior Education for more on this as well.

Back to how somatic therapy can help with dizziness. Learning how our own body and nervous system begins to ramp up and “activate” helps us identify what our body needs to get through these situations and move towards health and homeostasis. Everyone is different, and each situation is different.

3 Ways somatic therapy can help with dizziness

If we ignore these signs, or don’t have the tools to help support what our body is telling us, we can reach a point of overwhelm and our body shuts down on us. Pacing is the practice of identifying these activations, and working on tools to assist your body, a major part of what Kate and other somatic therapists are amazing at!

Pacing

Pacing involves going SLOW. This is not easy and takes practice. This makes us think about the exact moment we are in and what our body is experiencing. Go into a quiet room and focus on moving towards health. Focusing on what you’re feeling right now, what your body needs right now. This is abstract and hard, which is why lovely people like Kate are here to help guide you further. Pacing helps identify what you’re experiencing, and getting support systems in place. This is how somatic therapy can help with dizziness.

Over time and with practice, the goal is you start to learn more about your body and have tools to support it. Pacing helps you be more aware of your window of tolerance. It’s okay to have nervous system activation, people like Kate help you to identify and work through it. If you aren’t in touch with your body, it’s hard to move along various activation states tolerably.

Support Tools, Avoiding Hyperawareness, Derealization/Dissociation

It’s important to check in with your body with chronic conditions and symptoms to avoid doing too much, making it easy to become hyper vigilant of what you’re feeling.

Try and know that you know how to handle this, and you’ve filled your prescriptions, and you can call your doc if needed, you have a support system, and at the same time you need to let your brain set it down and enjoy the moment that you’re in. This is hard and takes repetition and practice.

What about derealization or dissociation?

These come with the feeling like you aren’t real. Like you’re watching your world through a TV. Feeling disconnected or viewing the world from a glass plane. These can be survival mechanisms (and that’s not a bad thing!)  but ways to try to shake this are:

Give these a try, did it help? These are a few of the ways somatic therapy can help dizziness, derealization and dissociation.

Contact info

Follow Kate for ongoing education or reach out if you have questions or are interested in working with Kate to see how somatic therapy can help dizziness, chronic pain and more! Click here to reach Kate’s website.

3 ways somatic therapy can help dizziness

Want to learn more about tools, how somatic therapy can help dizziness, and other vestibular tools to get back to your daily life?  Find out more at this link: https://tvd.flywheelstaging.com/about-group/

Disclaimer:

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

5 Main Audiology Tests for Vestibular Disorders
With vestibular audiologist Dr. Alexandra Smith, Au.D, CCC-A, F-AAA.

Dr. Alexandra Smith is based in Santa Fe, NM (you can find her clinic here) and works to identify, diagnose, treat and prevent various diseases, injuries or defects of the ear. Audiologists are also able to assist their clients with maintaining good hearing and can assist with hearing devices. Dr. Smith perform audiology testing for vestibular disorders and is going over them in more detail to help you better understand your test results and know what to expect. If you think you’d benefit from audiology testing for vestibular disorders, talk to your doctor about comprehensive audiology testing.

 

This blog post covers some content Dr. Smith covers with Dr. Madison Oak, vestibular physical therapist for our vestibular group fit members. These tests are common when evaluating for vestibular disorders but aren’t always well known or explained. Read below to learn more about audiology tests for vestibular disorders and what they can help tell you about your vestibular condition.

What is a vestibular audiologist?

A specialty within audiology which includes: 

  1. Hearing and tinnitus evaluations 
  2. Surgical implant care
  3. Vestibular evaluation
  4. Select vestibular treatments (like the epley maneuver for BPPV) 
  5. Diagnostic tests which we’ll go into more detail below! (ECOG, audiogram, VNG, brain wave testing, positional testing and more)

Using audiology tests for vestibular disorders can be another piece of information to consider with other testing (MRI, physical therapy, occupational therapy, ENT, Neurology etc) to best determine a plan of care to manage your vestibular condition. 

What is the role of a vestibular audiologist?

What does audiology testing and vestibular disorders have to do with each other? Anatomically, our inner ear has both a spatial awareness system (the vestibular system) AND hearing portions (the cochlea) that make up the inner ear. The nerve that connects our inner ear to the brain also branches from the same nerve to reach both of these sections. It is also common to have other ear symptoms or hearing changes with vestibular conditions, so it’s important to get  testing done by a specialist in the hearing portion of our inner ear, an audiologist! 

Audiology tests for vestibular disorders

What are the 5 main audiology tests for vestibular disorders?

Common audiology tests for vestibular disorders include: 

  1. VNG (Videonystagmography exam)
  2. Caloric testing 
  3. ECOG (Electrocochleography exam)
  4. VEMP (Vestibular evoked myogenic potential)
  5. Audiogram

Below, we’ll go into more detail on what these tests measure, what to expect, and how these tests can help with vestibular diagnostics. 

VNG (Videonystagmography exam)

Caloric testing

You are in control and can stop at anytime, it is NOT AN ATTACK.

ECOG (Electrocochleography exam)

VEMP (Vestibular evoked myogenic potential)

Audiogram

Can you have normal testing and still have a vestibular disorder?

YES! Certain vestibular conditions will not show up on this testing. Migraine will not show up on MRI, CT scans, ECOG VEMP or VNG or audiograms. These tests can still be helpful for these conditions that require a diagnosis of exclusion to rule out other conditions that these tests can reveal. Audiology tests for vestibular disorders can help lead us to identify specific diagnoses. If testing comes out normal, audiology tests for vestibular disorders can also help consider other diagnoses that would show normal testing. 

Audiology tests for vestibular disorders is one piece of testing to be considered with other providers testing and listening to what you’ve experienced. Listening to your experience and looking at all the test results can help get the right team of providers (OT, PT, Neuro, ENT) in your corner to start your healing journey. It’s natural for this team to change slightly, or change focus for periods of time with certain providers based on your needs. Keep your team in the loop so they can help adjust accordingly, they’re here to help YOU. 

 

Want to learn more about vestibular testing, ear pressure, tinnitus and other vestibular tools to get back to your daily life?  Find out more at this link: https://tvd.flywheelstaging.com/about-group/

 

Disclaimer:

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

Tips and tricks for traveling with a vestibular disorder

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

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

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

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

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

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

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

9. Eat a good breakfast on travel day. 

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

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

Traveling with a vestibular disorder by car

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

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

Traveling with a vestibular disorder by plane

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

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

Traveling with a vestibular disorder by train

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

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

Traveling with a vestibular disorder by boat

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

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

How to recover from traveling with a vestibular disorder

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

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

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


Click here

Disclaimer:

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.

Long-COVID rehabilitation: The best Treatment for Long-COVID

We all were affected by the COVID-19 pandemic, and because of that we have all heard of Long-COVID, and hopefully, about Long COVID Rehabilitation. And, no matter what happened to you or around you during the pandemic, somethings has become more and more prevalent over the last few months is Long-COVID. Long-COVID is a hot topic, and I want to start off by saying one thing: You are NOT making it up. I have worked in chronic illness since I gratulated from Physical Therapy school and I understand the gaslighting in the medical system, especially the US medical system. BUT, I am here to tell you that you are making that up. Most people with the COVID-19 virus recover within 1 week, but that’s definitely not the case for everyone. According to UCLA health, one in three people with a COVID diagnosis will develop Long-COVID.

So, today let’s talk about it: what is Long COVID Rehabilitation?

Are you making up Long COVID?

You are not making it up! I want you to know that this is not in your head.
Your symptoms, whichever way you may be presenting, are very real. I have seen many providers who either ‘don’t believe you’ or ‘don’t believe Long-COVID would be so severe’. But, I am here to say that there are many different and debilitating symptoms!
The biggest issue we are having is that we don’t have enough research on covid and Long-COVID, so many provider just don’t know what to do about it at this point.

What are Long-COVID symptoms?

Long-COVID symptoms can be incredibly variable and truly span anywhere from fatigue to cardiovascular issues. Your symptoms can be cardiovascular, respiratory, general fatigue, fever,  difficultly sleeping, and more. Because we just don’t know enough about Long-COVID right now, we can’t make an exact list. But, if you had COVID and now you’re experiencing symptoms you did not have before it could definitely be correlated with Long-COVID. Long COVID symptoms could last anywhere from a few weeks to years. COVID began in early 2020, and patients have been dealing with Long-COVID symptoms since that time. It’s difficult to say at this time if they last forever or not. However, it does seem like we are able to treat Long-COVID, though through LongCOVID rehabilitation and medication.

Long-COVID & Dizziness

Long-COVID is known to cause many different symptoms, as we discussed above. One of the overarching symptoms that we did not touch on above is dizziness. As a provider who treats dizziness and vertigo, I have been treating SO much Long-COVID. It started with just one patient who had dizziness related to COVID-19, but has been a very big influx of my caseload, especially for someone who treats Vestibular Migraine and PPPD usually.

Long-COVID Dizziness is thought to come from the virus infecting and inflaming your inner ear. Your inner ear controls balance and equilibrium, and spatial awareness. Without this organ functioning accurately, you will feel dizzy, light headed, and other related symptoms. Another Long-COVID dizziness diagnosis is POTS. POTS, or Postural Orthostatic Tachycardia Syndrome is an autonomic dysfunction. Autonomic dysfunction is your automatic systems in your body. Everything from digestion to heart rate and breathing are controlled by your autonomic system, because these are all involuntary. And, they’re REALLY important! Long-COVID rehabilitation, can help regardless of the type of dizziness you are experiencing after a Long-COVID diagnosis!

Long-COVID rehabilitation has had its difficulties in treatment, but it’s nothing that my patients and I haven’t been able to trouble shoot. Long-COVID is not one of those sicknesses that you get and then suddenly you just get 100% better again. There may be adaptation and compensations you have to make in your life, and your lifestyle may look a little bit different than it did pre-COVID. However, I do find that specific rehabiltation directed at each of your symptoms is incredibly effective in getting you back to at least some of your ‘normal.’

How do you treat Long-COVID?

Long-COVID is complex, and I like I said above, we just don’t know enough about it. But, we have seen that Long COVID rehabilitation is effective. Your symptoms can range anywhere from looks like POTS to seeming like a concussion. No matter what the symptoms, Long-COVID treatment is rehabilitation. Long-COVID rehabilitation providers are typically physical therapists and occupational therapists. There are also medical providers who have branched into this kind of medicine as well. There are a few studies that have shown to be somewhat effective in treatment with medication. At this time it is all preliminary information. UCLA and Stanford both have excellent West coast treatment centers. Additionally, there are a few others like in Kansas CityGermany, New York City, and more!

Treating Long-COVID from a medical standpoint and a rehabilitation standpoint is the best way to go about treatment overall. I recommend finding both a medical doctor and a physical or occupational therapist to help you rebuild strength, improve visual symptoms, reduce dizziness, and more.

Long-COVID Rehabilitation

Long-COVID rehabilitation will look like a few different kinds of physical therapy combined into one treatment plan.

At this point, there are not many experienced Long-COVID rehabilitation practitioners, none of have more than a year or so of experience. However, we all piecing together information the best that we can! If you are looking for a provider, I recommend calling around to physical therapist and occupational therapist offices and asking if they’ve had any experience working with Long-COVID rehabilitation patients. And, if there is not someone in your area, try and find someone who is at least willing to learn with you!

Currently, I am taking patients for Long-COVID rehabilitation in the following states via telehealth: Wyoming, Virginia, Maryland, California, New York, and New Jersey!

If you’d like to schedule an evaluation appointment to work with me, email me at [email protected] for more information!

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

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

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

What is visual vestibular integration?

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

 

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

 

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

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

What happens if visual vestibular integration doesn’t work?

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

How to promote visual vestibular integration.

 

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

  1. Eyes closed
  2. Eyes open with videos
  3. Firm surface
  4. Foam surface
  5. Standing feet apart or feet together. 

 

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

 

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

 

Disclaimer:

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.

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?


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Disclaimer:

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

Movement and exercise are two words that can be really triggering for people with chronic illnesses.
You may have heard someone say to you “just exercise, you’ll feel better,” but when we take that advice from our doctors the opposite effect might happen. More often than not, picking up a new exercise routine can actually make you feel worse if your symptoms and current state of chronic illness is not considered first and foremost.
Exercise can 1000% be used to your advantage, and you can absolutely reduce your sensitivity to movement, reduce the number of attacks you have, raise your threshold, and improve your quality of life through movement. But, not if you don’t do it with very specific intentions.
There are workouts designed for new moms, chronic pain, Multiple Sclerosis, and more. So, why not workouts for vestibular disorders, too?

That’s where Vestibular Group Fit comes in!

Vestibular Group Fit is the best workout for those with vestibular migraine and other vestibular conditions! It’s not feasible or logical for your healthcare provider to tell you to just ‘start exercising’ or for you to begin right after you finish vestibular rehabilitation therapy. It’s truly unfair to try and send you on your own. That’s why Vestibular Group Fit exists, to help you get back to a place where you can move your body comfortably, and not trigger an attack.
Vestibular Group Fit is a workout for those with vestibular disorders. Relearning how to do functional activities is one thing, but getting back to workout classes is an entirely different beast. There are so many triggers at the gym and regular workout classes! Fluorescent lighting, loud music, moving people, big weights, and more. All of these can be triggers that are incredibly irritating on your system. But, it does not have to be this way.
You can exercise and move in a way that promotes physical health, mental health, and vestibular health. This will ultimately reduce your dizziness, improve your confidence, help you get back to driving and the grocery store, and more.  You can raise your threshold to migraine attacks.
Raising your threshold comes from the threshold theory of migraine. This theory states there are are many different factors contributing to your migraine attacks, and when they all pile up you hit your threshold and have an attack. But, if you raise that threshold (which takes time and effort but is very doable) you will have fewer attacks and a higher quality of life.
Raising your threshold takes consistency over time. It takes movement, education and knowledge, and support. Vestibular Group Fit offers all of these things, it’s so much more than just a workout.
The Support group is filled with like-minded individuals who are on a journey toward healing through movement, mindset, and knowledge. These three things are some of the pillars of Vestibular Group Fit. And, when they’re consistently upheld, you will see the results you’re looking for.
Below is a link to learn more about Vestibular Group Fit, how it works, and how other people have been successful in their journeys through movement.


Click Here to Learn More!

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! 

Vestibular disorders, especially Vestibular Migraine, can cause neck pain and cervicogenic dizziness. However, thankfully, these are both manageable with vestibular physical therapy and cervical (neck) physical therapy. The neck is a complex group of muscles, bones, joints, and other soft tissues that can easily make you feel ‘off’ or out of place.

Luckily, that feeling does not have to last forever. Cervicogenic dizziness and other neck dysfunctions are very treatable. One of my favorite ways to manage cervical issues is stretching. Here are my twoi favorite stretches:

Pectoral stretch

Your pec muscles are located in the front of your chest. You have 2 on each side, the pec major, and the pec minor. The pec major is larger and lays on top of the pec minor. To stretch them both, you need to perform 2 different stretches for best results. In this video we see three stretches.The first two stretch the pec major, and the last stretches the pec minor. The further up the doorway you place your hands, the more you’ll get into the pec minor.

Trapezius stretch

If the back of your neck is bothering you, it can come from your chest, but another great stretch is a trapezius stretch, which will help stretch the back of your neck. The back of your neck is made up of quite a few muscles, but the biggest one, which tends to feel knotty, is the trapezius muscle. Here’s my favorite way to stretch the back of my neck. Watch the video, and if you want a second stretch for a similar movement, don’t twist your head!

What else can help neck pain?

Other than stretching, many things can help with neck pain. General exercise, improving your posture, and taking breaks from sitting.

General Exercise?

Exercise is good for us. Whether or not we’d like to admit it, we know that it’s something we should participate in regularly. There are a few exceptions, but it’s statistically unlikely that you’re in that group of people. If exercise makes you dizzy, or you’re worried that it could make you dizzy, Vestibular Group Fit is the answer to your issue. Vestibular Group Fit is the all-in-one, holistic solution to strengthening your vestibular system, helping you to move, and more! This helps you get rid of your neck pain through movement, and will help you prevent dizziness attacks in the future!

Improving your Posture

Your posture is just as important as your mom said it would be. If you ever thought that you may be having dizziness BECAUSE of your neck, your posture could be playing a roll. Your posture is in charge of where your head is – it’s all about your neck. If you neck is giving your brain a ‘bad’ signal about where your head is in space, it gets confused and send a dizziness signal. But, it can be treated with Cervical Physical Therapy and Vestibular Group Fit!

Taking Breaks from Sitting

Sitting for too long can be harmful to our posture, and if we remember from above, our posture can make us feel dizzy if it’s poor. In a world where we all work from home, it can be easy to get into the routine of sitting at your desk and not leaving until you finish work, except maybe a trip to the kitchen or two (I am guilty of this myself). Instead, it’s vital to take sitting breaks. Every 45-60 minutes stand up, walk to get a glass of water (yay, hydration!), grab a snack, or just take a lap around the house. It doesn’t matter what you do, but set a timer and make it happen! It will help your neck, back, and vestibular system!