Learning to live with Vestibular Migraine is a life-long process, but tips and tricks from those with Vestibular or other forms Migraine can be so helpful. However, it is sometimes hard to find an all inclusive list of things that people have found helpful in the past. This is a list, which will be continually updated, containing items that patients have found to be helpful!
Lifestyle:
Allay Lamp
The Allay lamp’s intention is to decrease migraine triggers by emitting a calming green light that is proven to decrease photophobia, anxiety, and stress. We know that there are many wavelengths of light, which make up the whole world of colors, but for those with Migraine most of those lights are intolerable. Wearing migraine glasses is one solution, but another is to use this lamp. This lamp triggers small electrical responses in your brain, instead of large electrical signals that most bands of light cause. You can dim it, place a shade on one side for decreased light overall, or change it to a whiter light that is still soothing.
Migraine Glasses
There are so many pairs of glasses my patients have found to be helpful. Migraine glasses are intended to block blue light, in addition to yellow and other waves of light. Blue light ranges from 400-750nanometers. Because it is such a wide range, different kinds of blue lights are more and less problematic for your migraine and related symptoms. Some blue light glasses block only some parts of the blue light spectrum, even the parts that are good for you. Blue light around 460-500nm is actually healthy – we use blue light to monitor our melatonin levels, which affects our sleep-wake-cycle. Blue light can even be used to treat Seasonal Affective disorder. Blue light below 430nm is the “bad” blue light. The intention for a good pair of blue light blocking glasses is to block the blue light under 430nm. Special migraine glasses, like Theraspecs and Migraine Shields, and AxonOptics glasses do just that!
TheraSpecs
Theraspecs are the pair of glasses I let patients use in the clinic. I really like them as the pink hue from the FL-41 glasses are soothing for many of my patients, and they were created by a person in the Migraine Community. According to their website, TheraSpecs wearers experience 74% fewer migraine attacks on average per month, which for people with photophobia (light sensitivity) will make a huge difference. Even if you aren’t sensitive to light, Theraspecs will make a difference!
Theraspecs work to block the harmful blue light waves, provide wrap around protection of your eyes, and focus on blocking blue light the most at 480nm, the most aggravating wavelength for those with Migraine.
Migraine Shields
Migraine Shields are the best pair of glasses if you don’t want any color distortion in your vision. Most migraine glasses have FL-41 lenses, which are tinted pink – Migraine Shields uses a slightly different technology and aren’t tinted pink. These are great for work environments, using the computer, or choosing anything where color might be important. Migraine Shields do not come in a large enough size to fit over other glasses if you have a prescription! However, Migraine Shields have just released readers. These readers come in many shapes, sizes, and are so much cuter than the ones you find at the drugstore – these really multitask and are SO helpful!
AxonOptics
AxonOptics are also a great option for Migraine relief. They are not too pink, lightweight, and come in three different tints. AxonOptics glasses have three tints for three intentions: indoor, outdoor, and transitional. Transitional lenses take a little longer to make, and they are a little more expensive. However, if you are going to purchase 2 pairs anyway, it may be worth it.
Research has found that FL-41 lenses need to be specifically made for people with light sensitivity. AxonOptics creased their specific glasses for Migraine by crafting a lens that is consistent, effective, and a nice color. Additionally AxonOptics has a plethora of frames you can choose from, and an option for contact lenses.
These can also be in the form of prescription eye glasses – if you’d like them to fill your prescription they can do that so you can still be working with these on!
Why Not Just Wear Sunglasses?
Sunglasses, while they may provide relief for your migraine in the moment, block too much light. If light is a trigger for you already, you don’t want to make it an even bigger trigger than it is already. When you wear sunglasses all day, inside and outside, it blocks many wavelengths of light, not just those in the blue light spectrum which work to block the provocative forms of blue light. If you block many kinds of light, not just the ones that typically affect migraine, you may end up sensitizing yourself too all light, making your triggers worse!
Headache Hat:
The headache hat is a tool you can use to soothe the headache part of your Vestibular Migraine, if you have them. I have found that patients in the middle of an attack will get their headache hat from the freezer, and feel at lease some relief. I would put the entire thing in the freezer, so you don’t have to deal with putting it together when you’re in the middle of a Migraine attack. It’s an easy, natural, way to give yourself a little relief.
Food and Beverages for Vestibular Migraine:
Imperfect Foods Subscription:
Imperfect Foods is a weekly delivery of produce, meat, dairy, and snacks that is completely customized to your liking. You can choose what you’d like to go into the box, and they’ll deliver it to you on a set day for your whole neighborhood. I love Imperfect Foods, as they deliver the food that would normally be thrown out by grocery stores – your produce sometimes looks funny or misshapen, but is perfectly consumable!
They have options for organic or non-organic, and many other fun products that will make your life easier for when you really don’t want to go to the grocery store!
Click the link above, or here, for $20 toward your first week!
Ritual Zero Proof:
Ritual Zero Proof is a whiskey, tequila, or gin alternative that tastes like the real thing, but without the alcohol! It really does taste like the real thing, but has no alcohol, no hangover, and no migraine! This was started by three people who do drink but wanted an additional way to enjoy a cocktail that wouldn’t give them the tipsy feeling. Although not intended for a vestibular migraine diet, it fits perfectly into your lifestyle!
PureWine Wands: Sulfite Removers
Sulfites and histamines can be part of your trigger load. Because wine, and other food & beverage categories, can contain quite a few sulfites finding ways to avoid, or remove, the sulfites is helpful! PureWine Wands remove the sulfites from the wine, which are produced by the grape skins during fermentation, and naturally occur in almost all, if not all wines. Removing these will help, but make sure you follow the directions as they do have to sit for a while to be effective.
You can use the wands, for a glass of wine
Or the wave for an entire bottle!
Books for Vestibular Migraine:
There are a few books that Migraine patients should read, whether you have Vestibular Migraine or another kind of migraine. These will all help you understand Migraine and how to manage your symptoms
Victory Over Vestibular Migraine:
This book is by well-known neuro-otologist, Dr. Shin Beh. He goes through the steps from finding out you have Vestibular Migraine to learning what to do next in order to manage your Vestibular Migraine symptoms. This is an absolute must-read for all vestibular migraine patients – either if you have a new diagnosis or you’ve been managing your symptoms for a long time.
The Migraine Brain:
This was the first Migraine book I read when I started treating patients with Migraine. It really helped me understand the vastness of triggers a person can have, how to manage the symptoms, and what a migraine actually is. It’s around 300 pages, but it’s a quick read and it has charts in the back to help you analyze your migraine!
Heal Your Headache (The 1-2-3 Program for Taking Charge of Your Headaches)
This book will give you a step-by-step guide for dietary recommendations for migraine and vestibular migraine. It will take you through the elimination and reintroduction of foods into your diet for a successful migraine lifestyle!
This is a short list of many Vestibular Migraine Hacks that will help make your lives easier! Check back soon for more helpful products and tips as this list grows!
When you are diagnosed with a vestibular disorder, you may be prescribed a pharmaceutical by your physician. These can either control your symptoms, or treat the dysfunction at its core. Vestibular suppressants work to suppress your system to decrease the uncomfortable symptoms of dizziness, motion sickness, and vertigo. Vestibular suppressants are in three drug classes: anticholinergics, benzodiazepines, and antihistamines. Other pharmaceuticals like steroids and diuretics are also prescribed for different vestibular disorders and work to treat the cause of your symptoms. Everyone has different symptoms and different needs for medications, so the following is a very brief overview of medications I find are most commonly prescribed with vestibular disorders. Always be sure to talk to your physician and pharmacist before starting, stopping, or changing a medication.
Benzodiazepines – these are medications typically used for anti-anxiety and antidepressant purposes. However, they also act as vestibular suppressants and work to reduce dizziness in many vestibular disorders by reducing anxiety and motion sickness symptoms. Taking these for long durations should be avoided to decrease risks of lasting side effects like impaired memory and increased risk for falling (1).
Antihistamines – these are medications like meclizine and diphenhydramine (Benadryl). These help prevent motion sickness and reduce vestibular symptoms when you are having a dizzy spell. They are only effective in treating the symptoms, not the root cause of your dizziness.
Anticholinergics – these are medications that inhibit the firing of the vestibular nucleus and reduce vestibular nystagmus(1). Common anticholinergics are meclizine and scopolamine.
Diuretics – diuretics are prescribed to keep your sodium and fluid levels stable. Diuretics can be used for many purposes, but they’re prescribed to treat combat vestibular disorders such as Secondary Endolymphatic Hydrops. Those who are unable to treat their symptoms conservatively with a low sodium diet often use this as the next step in treatment.
Betahistine – this drug is prescribed to those who have been diagnosed with Ménière’s Disease (1). This is a medication that controls Ménière’s Disease by taking it daily. It tends to reduce the number of attacks, but usually doesn’t prevent them all together (2). It is very important you discuss this medication with your physician prior to beginning treatment, and taking it exactly as advised.
Steroids – steroids are prescribed to individuals with vestibular neuritis or labyrinthitis. Steroids are effective in treating both of these in the first 24 hours of symptom onset. They are used to effectively reduce swelling and edema on the vestibulocochlear nerve and lead to positive long term recovery compared to those who did not get the treatment within 24 hours (3). Taking these for extended durations can lead to loss of bone density and other negative effects, so be sure you’re talking with your physicians before you start, stop, or change medications!
Antiemetics – these work to control nausea and vomiting. Commonly prescribed antiemetics and Zofran and Decadron. Taking medication like this is sometimes recommended during a treatment for BPPV to prevent nausea; talk to your physician to discuss your options!
Meclizine – this medication is prescribed very frequently to suppress the vestibular system, to reduce nystagmus and vertigo symptoms. Meclizine is an antihistamine and an anticholinergic. These decrease nausea, prevent motion sickness, and reduce vestibular nystagmus. Clinically, I find that this is the most commonly prescribed medication by physicians for dizziness when symptoms first begin.
Zofran – this mediation is an antiemetic. This is prescribed to treat nausea in patients with vertigo and dizziness symptoms.
Sources:
(1) Yacovino, D. (2020, September 10). Medication. Retrieved September 17, 2020, from https://vestibular.org/article/diagnosis-treatment/treatments/medication
(2) Stewart, M. (2019, May 16). Betahistine information. Betahistine side effects. Retrieved September 17, 2020, from https://patient.info/medicine/betahistine-tablets-serc
(3) Sjögren, Julia; Magnusson, Måns; Tjernström, Fredrik; Karlberg, Mikael Steroids for Acute Vestibular Neuronitis—the Earlier the Treatment, the Better the Outcome?, Otology & Neurotology: March 2019 – Volume 40 – Issue 3 – p 372-374 doi: 10.1097/MAO.0000000000002106. https://journals.lww.com/otology-neurotology/fulltext/2019/03000/steroids_for_acute_vestibular_neuronitis_the.21.aspx
Vestibular Rehabilitation Therapy
Vestibular rehabilitation therapy (VRT) is a specific type of treatment designed to improve symptoms related to the inner ear, also known as the vestibular system. Research has shown that VRT can decrease vestibular symptoms and help you return to your normal activities. A physical therapist will determine if you will benefit from VRT and select exercises based on your specific needs and goals (1).
Common vestibular symptoms are:
- Dizziness
- Imbalance
- Motion sensitivity
- Ringing in the ears (tinnitus) or changes in hearing
- Ear fullness or ear pressure
- Nausea or vomiting
- Fatigue
- Difficulty concentrating
- Anxiety
- Depression
What should I expect?
A physical therapist will ask you questions to gather a history of your condition and lead you through a physical exam to determine if VRT is appropriate for you. Most treatment plans consist of a home exercise program and meetings every 1-2 weeks with your physical therapist to progress exercises, answer questions, and address any new changes. Your therapist may also suggest seeing other providers such as an ENT, audiologist or neurologist to best treat your condition. You may need to be seen for only 1-2 weeks or you might need to be seen over a course of 3-4 months, depending on a variety of factors (2).
Why does VRT work?
Your brain receives information from your vision, sense of touch, and inner ear to know where your body is in space to stay balanced. Certain events can weaken the connection from your inner ear to your brain, changing the information your brain is receiving. At first, your brain has difficulty processing this new information, resulting in increased symptoms. Based on a concept called neuroplasticity, your brain is able to form new connections and adapt to new information. VRT exercises encourage brain adaptation by strengthening the connection between your inner ear and brain. As your brain forms new connections and learns to correctly interpret sensory information, your symptoms will begin to decrease(1,2) .
To retrain the brain and encourage adaptation, VRT exercises will recreate or slightly increase symptoms, followed by a short recovery period to let symptoms return to normal. This is needed for your brain to learn that it’s safe to move without producing symptoms. As you improve, it will take more challenging exercises to elicit symptoms until you are able to participate in daily activities symptom-free (2).
How long does it take to recover?
Recovery is very dependent on you. Recovery can take 1-2 weeks or 3-4 months depending on personal factors such as diagnosis, lifestyle habits, medications, or additional medical conditions. An important part of recovery is regularly performing home exercises. Typically, after 1-2 weeks of regularly performing home exercises, you will notice a change as your brain begins to adapt.
Will my symptoms return?
You may experience a flare-up of symptoms after an illness, surgery, increased stress, dietary or medication changes, allergies, or other causative factors. If you experience a change in your symptoms, talk to your physician and physical therapist to reevaluate your condition and provide recommendations. Typically your symptoms will be less severe than the initial event, allowing a faster recovery (2).
15-minute rule
If it takes more than 15-20 minutes for your symptoms to return to normal, either during prescribed exercise or daily activities, that is a sign the activity was too intense. Next time you’re performing that activity, take frequent breaks to check your symptoms and allow for recovery as needed. This will continue to help retrain your brain.
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/
Sources:
(1) Cabrera King, Christian M, and Ronald J Tusa. “Vestibular Rehabilitation: Rationale and Indications.” Pub Med, Sept. 2013, www.researchgate.net/publication/256931442_Vestibular_Rehabilitation_Rationale_and_Indications.
(2) Farrell, Lisa. “Vestibular Rehabilitation Therapy (VRT).” VeDA, 25 Aug. 2020, vestibular.org/article/diagnosis-treatment/treatments/vestibular-rehabilitation-therapy-vrt/.