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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:

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

Let’s Break These Down:

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

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

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

Poor Integration Between Your 3 Balance Systems

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

Your Vestibular System is Fatigued

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

Your Bed is an Uneven Surface

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

You have anxiety about ‘causing’ BPPV

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

So What if you Want to Fix the Swaying?

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

Click here to join us!

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!

Treating a vestibular disorder can feel impossible – but here’s the good news, it is not impossible to treat a vestibular disorder! I have to say this first: do not give up hope when trying to treat your vestibular disorder. Dizziness can lead to infinite doctors appointments, feelings of frustration, and thinking that you might throw in the towel.

Vestibular Disorder Treatment

Vestibular Disorder treatment does require hard work and multiple doctors who know what they’re talking about. If you haven’t found one yet, please check VEDA (or here if you’re in the UK). Treatment is multimodal, meaning that you need multiple healthcare providers to do their jobs together as a team to help you- this is not a single-doctor-only diagnosis. It’s essential that your whole team works together, talks you each other, and is aware of your plan and changes to that plan.

Top Three Tips for Dizziness Treatment

Track your triggers (in the short term)

Tracking your triggers means that you should write down what you eat, the weather, your sleep, and your symptoms daily. I recommend doing this for four weeks. For some, this becomes a stress-inducing habit, and if that is the case for you, please do not do this and enlist the help of a professional!

Find an Excellent Healthcare Team

Finding healthcare providers that treat vestibular disorders can be difficult, but finding a person to listen to you and help you differentiate the diagnoses is endlessly helpful. IF you can’t find a provider on the VEDA link above, find a neurotologist to help you in your area or via telehealth. Most of the exam when diagnosing dizziness is subjective. If you’ve been to multiple doctors and already had standard testing (MRI, CT, etc.), you may be able to go to an out-of-state doctor via telehealth. Another important team member is a vestibular physical therapist. PTs are the ones who are going to help you get your life – return to function is through PT!

Be Consistent about your Treatment

Consistency is key in any major life change, especially with chronic illnesses. There are no quick fixes. Finding things that work for you can be a long journey, but it is helpful in the long run. If you can consistently change a few things here and there, it is often more valuable than making one significant change. Again, treating vestibular disorders is a holistic journey. You will likely trial and error many treatment options before you find out what works for you. Keep track of what you have tried (write it down, I love to do this in an excellent journal), keep a record of your symptoms and your flare-ups, and also track what did not work. Medications, diets, and more have likely been thrown at you, and trying many routes isn’t a bad idea.

Finding your Beginning

Everyone begins at their beginning – we don’t have the same starting point as anyone else. It’s important to remember that even when we ask others who have been where we are now for help, they had their journey and beginning. Be careful not to get caught up in someone else’s beginning – find yours and stick to what works for you.

Stay the Course

Vestibular disorder treatment is a long and often grueling journey. Finding something that will work for you can sometimes be daunting, but there truly are always options. You can always fire your doctor if they don’t listen to you. you are welcome to try something new if your think it will work for you. Do not give up – keep on pushing through, even on the hard days where it feels impossible.

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

What is fatigue?

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

What does Deconditioning Have to do With fatigue?

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

How Strength Training Helps Fatigue

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

Energy Conservation for Fatigue

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

Delegation

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

Time management

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

Task Grouping

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

Task simplification

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

Interval Rest

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

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

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

Click Here To Learn More

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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!

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.

Vegetable oils
Soybeans
Corn/corn oil
Eggs
Some meat and fish

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.

Salmon, mackerel, or other fatty fish
Seaweed and algae
Chia and hemp seeds
Walnuts
Edamame
Oysters & shrimp
Spinach & Brussels
Supplements

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.

When do you start vestibular rehabilitation therapy? That’s a big question that I get very frequently because starting Vestibular Rehabilitation Therapy can be a big decision. It’s a big commitment to yourself, it can be a big financial commitment, and parts of it can be difficult and uncomfortable.

Vestibular Therapy’s intention is to push you to the edge of dizziness and discomfort without making you too dizzy, to make you stronger. It’s a very fine line, and, if you’re not ready for it yet, it can make your symptoms worse. I say this not to scare you away from starting Vestibular Rehabilaition, but to prepare you for whatever may arise.

When Am I Ready for Vestibular Rehab?

Vestibular rehabilitation therapy can almost always be useful, but that does to mean it’s useful from day 1 of your diagnosed vestibular disorder. Vestibular rehabilitation is most effective when you are medically stable, and you are willing to feel a little bit dizzy during your exercises. Even if you are willing to put 100% effort into VRT, it doesn’t always mean you’re ready. You may not be ready to start Vestibular Rehab if a singular movement of your head makes you too dizzy to go about the rest of your day. In these cases, seeking help from a physician for medical intervention is a better idea for the time being.

All of that being said, I always think it’s a good idea to get an evaluation. That way, you can know if you are ready for VRT, you have the contact of a great physical therapist for when you are ready, and if you are ready, you can go ahead and begin!

What Should I Expect in Vestibular Rehabilitation Therapy?

Vestibular Rehabilitation Therapy is supposed to make you dizzy, but it is NOT supposed to ruin your whole day. A mild increase in dizziness is specifically intended to target your brain’s vestibular error system. It’s very important that you push into this error system in order for your brain to relearn what ‘normal’ feels like. Your vestibular system is receiving an incorrect

What to Look for in a Good Vestibular Therapist?

Finding an excellent vestibular physical therapist can be quite difficult. Vestibular Rehabilitation Therapy can be a long journey, and having someone on your team for the whole ride is important. Finding someone who you feel comfortable speaking to about your symptoms, who you feel like listens to you, and works to understand your symptoms.

Here are a few red flags:

If your therapist/provider gives you a list of pre-made exercises that are not relevant or scaled to you
If your therapist/provide gives you Brant-Deroff or Cawthorne Cooksey exercises without explanation
If your therapist/provider does not listen to your complaints and/or does not make your appointment about you
If your therapist/provider does not seem up to date about the research
If your therapist/provider is not a vestibular specialist
- There are a few programs that provide excellent vestibular education, and it’s not education we get from our basic physical therapy education. Ask your provider what continuing education they’ve done to help prepare them to be a vestibular specialist

When Will I Notice a Difference in My Dizziness Symptoms?

Vestibular Therapy is incredibly effective. Typically, within weeks, you will be able to notice a difference! Most research shows that you can probably see a difference within 4-6 weeks, if not more quickly. This does not mean you will feel 100% that quickly, but it does mean you will be more functional, less dizzy, more balanced, and be able to run more errands without as much difficulty. Vestibular Rehabilitation should be all about function, if you aren’t seeing a difference in your ability to live your life comfortably, ask your physical therapist to change your program.

What About Telehealth?

I have found that my patients who do VRT via telehealth have been just as successful, if not more successful, than those who have done Vestibular Rehabilitation in person. This is because being comfortable in your own home, in a familiar place, and not getting dizzy on the commute to the clinic all make it easier to do your exercises. Although there is some benefit to being able to see a patient in person, I have not seen a difference in outcomes from the patients I used to see when I worked in a clinic, to the patients I see now via telehealth. It is incredibly powerful, and oftentimes more effective than seeing patients in person!

Are You Interested in Working With Me?

I offer Vestibular Rehabilitation Services in New York, New Jersey, California, Virginia, and Maryland via telehealth. It’s an incredibly powerful service, and all my patients have been very successful. To learn more, email me ([email protected]) or go to our Contact Us page and shoot me a message! I will report within 24 hours!

Are you located elsewhere?

Fid a Vestibular Therapist in the US: https://vestibular.org/healthcare-directory/

Find a Vestibular Therapist In the UK: https://www.acpivr.com/find-a-physio/

Physical therapy for vestibular disorders, Vestibular Rehabilitation Therapy, Vestibular Therapy, or VRT is one of the most impactful and effective treatments for people living with vestibular disorders. Just about all people with vestibular disorders, including Vestibular Migraine, Vestibular Neuritis & Labyrinthitis, Superior Semicircular Canal Dehiscence, Meniere’s Disease, Acoustic Neuroma (pre and post-surgical), and others, can benefit from Vestibular Therapy.

Vestibular Therapy is most common in the treatment of Benign Paroxysmal Positional Vertigo, BPPV. Treated with a Canalith Repositioning Maneuver, this kind of true-vertigo can usually be treated in 1-3 sessions of Vestibular Therapy.

In addition to treating BPPV, Vestibular Therapy aims to improve vestibular system strength. Symptoms of dizziness, lightheadedness, gaze instability, gait & balance abnormalities, and general fear of movement are just some of the symptoms Vestibular Therapy treats.

In general, we have a tendency to think of Physical Therapy as the treatment for musculoskeletal and neuromuscular disorders. While yes, physical therapy is incredibly effective for those with knee pain, who are post-stroke or need help returning to exercise postpartum, it is also incredibly effective in the treatment of Vestibular disorders.

Vestibular Rehabilitation Therapy Research

In clinical practice, I see Vestibular Rehabilitation Therapy change the lives of many people. Some people who haven’t been able to shower without a shower chair for more than 5 years can now comfortably stand in the shower and bathe. Others who have wanted to return to exercise but have been too nervous to move are now running long distances. Although there are many success stories similar to these, there is also research to back up these claims.

Vestibular Rehabilitation Therapy for Vestibular Migraine

Because of the lack of general research and criteria, there is no specific protocol to treat Vestibular Migraine, however, research does find that Vestibular Rehabilitation can improve Vestibular Migraine symptoms. Symptoms such as motion sensitivity, imbalance, spatial disorientation, and more are those we aim to treat. According to a 2009 study by Whitney, et.al., patients who have migraine attacks and migraine-related vestibulopathy benefitted from Vestibular rehabilitation Therapy, especially when combined with pharmaceutical management (1). Another article, a systematic review of articles, showed that Vestibular Rehabilitation Therapy was effective in treating subjective and objective complaints of vestibular symptoms.

Vestibular Rehabilitation Therapy is also found, in this 2017 article by Sugaya et.al., to improve headache symptoms, as well as symptoms of dizziness, and tension-type headache in those with vestibular migraine (3). All of this research, and more, can be found to show that vestibular symptoms of Vestibular Migraine can effectively be treated by Vestibular Rehabilitation Therapy.

Vestibular Rehabilitation Therapy for Unilateral Vestibular Hypofunction

A unilateral vestibular hypofunction is one of the most common causes of vestibular dysfunction and general disorientation and dizziness. This study sought to determine whether Habituation or Gaze Stability (AKA Adaptation), two common Vestibular Rehab protocols, was more effective (4). The research concluded that both were incredibly beneficial, and all treatment groups had positive outcomes. One treatment group used Gaze Stability exercises, and the other group used habituation exercises. After 6 weeks, both groups saw improvements in both habituation and adaptation outcome measures. This research shows, and otherwise cites, that the only ineffective treatment is to do nothing at all.

Vestibular Rehabilitation Therapy for Mal de Debarquement Syndrome

Mal de Debarquement Syndrome, or MdDs, is the sensation of rocking and swaying chronically, that gets better with passive movement and worse with being still. Classic Vestibular Rehabilitation Therapy is not very effective for the specific MdDS symptoms, but it does work to improve your balance and ability to walk. Your vestibular therapist could also help you with the Dai Protocol, which is the best possible treatment option for those with Mal de Debarquement syndrome.

What Else can your Vestibular Therapist Help you with?

A vestibular therapist cannot officially diagnose you with a vestibular disorder, however it’s really common that your vestibular therapist understands vestibular disorder diagnoses better than other healthcare professionals. Great vestibular therapists are typically vestibulo-holics (we LOVE treating dizziness). Not only will we help you return to gentle movement, but we can help empower you to talk with your doctor about a correct diagnosis, help you understand your vestibular disorder better, help you understand which supplements you may need to take, and more.

If you are a person who wants to return to the grocery store, driving, walking, cooking, and more without dizziness, Vestibular Rehabilitation Therapy with an excellent vestibular therapist can absolutely be of help to you!

When to Begin Vestibular Rehabilitation Therapy

Vestibular Rehabilitation Therapy is most effective when you are actually ready for it. But what does that even mean?

Vestibular Rehab is effective, the research shows that whether you have a unilateral vestibular hypofunction, Vestibular Migraine, or other vestibular pathology, Vestibular Rehabilitation Therapy should be a part of your recovery plan. However, starting before you are really ready for it can actually be discouraging and ineffective.

In my practice, I have found that VRT is most effective when my patients are in a sub-acute phase. This is mostly anecdotal, but you will find that better vestibular specialists don’t always refer patients to Vestibular Rehabilitation Therapy immediately after diagnosis.

There are of course exceptions, for instance, diagnoses like Vestibular Neuritis need immediate Vestibular Rehabilitation Therapy and should be referred to a PT quickly. Vestibular Neuritis is a form of unilateral vestibular hypofunction, and you can read more about it here. In this case, it’s important to get to VRT immediately to help your system recover. You will learn about why you’re feeling dizzy, what to do during a flare-up, and how to improve your vestibular system’s strength to increase gaze stability and habitation.

In Vestibular Migraine, however, it’s not always best to begin immediately. Vestibular Migraine patients can be incredibly delicate, and more movement in the acute phase can cause a worsening of symptoms. I evaluate many newly diagnosed Vestibular Migraine patients, and as much as I want to help them as quickly as possible, I send quite a few away for weeks to months at a time. It’s a hard line to walk because beginning to move more can be frightening at first, and you may never really feel ‘ready’. However, if you talk to a vestibular therapist, and your referring physician, there is usually an excellent plan of attack. It can’t hurt to get an initial evaluation from a vestibular physical therapist and then make a plan. Maybe you should start now, maybe you should start later – it’s always between you and your healthcare team!

Still not sure when or how to begin?

Start by finding a vestibular physical therapist here, ask for an evaluation, and see what the therapist has to say. If he or she feels like you are ready, and you are committed to starting, then I say go for it!

Or, if you reside in Maryland, Virginia, California, New York, or New Jersey contact me for a free 10-minute consult to see if we’d be a good fit!

Sources:

(1) Whitney, S.L., Wrisley, D.M., Brown, K.E. and Furman, J.M. (2000), Physical Therapy for Migraine-Related Vestibulopathy and Vestibular Dysfunction With History of Migraine. The Laryngoscope, 110: 1528-1534. https://doi.org/10.1097/00005537-200009000-00022

(2) Alghadir AH, Anwer S. Effects of Vestibular Rehabilitation in the Management of a Vestibular Migraine: A Review. Front Neurol. 2018;9:440. Published 2018 Jun 12. doi:10.3389/fneur.2018.00440

(3) Sugaya, N., Arai, M., & Goto, F. (2017, April 3). Is The Headache in Patients With Vestibular Migraine Attenuated By Vestibular Rehabilitation? Frontiers in Neurology. https://www.frontiersin.org/articles/10.3389/fneur.2017.00124/full.

(4) Clendaniel RA. The effects of habituation and gaze stability exercises in the treatment of unilateral vestibular hypofunction: a preliminary results. J Neurol Phys Ther. 2010;34(2):111-116. doi:10.1097/NPT.0b013e3181deca01