COULD YOU HAVE A VESTIBULAR DISORDER?

16th January 2017

Most people associate migraine with severe head pain and a period of incapacitation.  However, a large portion of people with migraine don’t have accompanying pain, their predominant symptoms instead being vertigo (a spinning sensation), dizziness, disequilibrium (loss of balance), disorientation, visual distortion or altered visual clarity.  This presentation may result in a visit to A & E, a multitude of medical professional consultations and extensive laboratory, imaging and other diagnostic evaluations – often with normal results which lends to increased confusion and anxiety on the part of the patient.  In addition, vestibular suppressant medications are often given, increasing postural instability and further compounding the situation.  Without a diagnosis, but with persisting symptoms, patients become disillusioned and hopeless.  Some patients are given a diagnosis of ‘vertigo’ which is in fact a symptom – not a disorder.  That’s why many people with these symptoms can go undiagnosed for several years incorrectly thinking that their only choice is to live with it. Like any condition, accurate diagnosis is the essential starting point and so once these patients are diagnosed with Vestibular Migraine, they can then be successfully managed.

What is Vestibular Migraine?

The vestibular system includes the parts of the inner ear and brain that process sensory information involved in controlling balance and eye movements.  Migraine is a complex neurological disorder which weakens the vestibular system causing a disruption in its functioning and results in the vestibular disorder. Vestibular Migraine is also known as migraine vestibulopathy, migraine associated vertigo or migraine related dizziness. Approximately 40% of migraine patients have some accompanying symptoms involving disruption in their balance and/or dizziness at one time or another.  These symptoms can be prior to, during, after or totally independent of the migraine event.  More detailed information can be found on www.vestibular.org

Who gets it and why?

Just as migraine can be inherited, so too can Vestibular Migraine, giving rise to a family vulnerability to this disorder.   “Often my Vestibular Migraine patients report a family history of migraine but on some occasions there is only a family history of ‘vertigo’ stemming from misdiagnosed Vestibular Migraine” says Sheila Barrett.

Causes?

The known migraine triggers such as certain foods and environmental, emotional and hormonal changes can also trigger Vestibular Migraine.    More details of migraine triggers can be accessed from this website here. 

Symptoms?

On clinical presentation sufferers report symptoms that may include – but are not limited to the following:

  • vertigo (illusionary spinning of the environment),
  • dizziness (spinning or light headedness inside the head),
  • disequilibrium (off balance),
  • photophobia (light sensitivity, always liking to wear sunglasses and disliking fluorescent lights),
  • phonophobia (sound sensitivity),
  • motion sensitivity (may feel nauseous when travelling in a car but very often the sufferer may only have a history of being a ‘poor traveller’ as a child in the back of a car and may no longer be motion sensitive as they now drive their own car),
  • increased dizziness with head movements, neck stiffness and ache (which can be as a result of holding their neck rigid in order to avoid provoking dizziness)
  • ‘muzzy’ head causing poor cognitive function (a most distressing symptom when trying to work or study for an exam)

Patients can often suffer anxiety and depression as a result of enduring some or all the preceding symptoms without clear diagnosis and treatment options.

How is it diagnosed?

There is no single test to diagnose Vestibular Migraine. Diagnosis is based on medical history and by performing appropriate tests to rule out other causes of symptoms.  One such test is functional vestibular testing using infra-red goggles.

How is it treated?

Successful management of Vestibular Migraine has to be two fold, as its name would suggest.  Firstly, the patient should learn to identify and manage their migraine triggers, just as with any migraine condition.  Secondly they must strengthen and rehabilitate the vestibular weakness with vestibular rehabilitation therapy (VRT) from a qualified vestibular physiotherapist.

What is vestibular rehabilitation therapy?

Many research studies have scientifically proven that patients with Vestibular Migraine improve with VRT.  Sufferers usually avoid head movements, moving ‘en bloc’ by holding their neck rigid to avoid provoking dizziness and imbalance.  They may limit activities such as avoiding playing sport, shopping, socialising and many adopt a sedentary lifestyle for fear of aggravating symptoms.  In doing so they are further weakening their vestibular system and in fact it is the exact opposite they should be doing.  They need to move in order to strengthen the vestibular system.  The rational for movement is based on the scientific proof that head movements which provoke the patient’s dizziness play an important role in hastening the recovery process.  However, you cannot simply tell a dizzy patient to ‘MOVE’, it has to be in a systematically, progressive manner.  This is where VRT comes in which is a systematic exercise based programme. Tailored exercises which include very specific head and eye movements which provoke symptoms of dizziness in a mild and controlled manner.  These de-sensitise and / or promote re-calibration of the vestibular system.

Other patients with migraine associated vertigo become very visually sensitive (visual vertigo) where busy visual environments such as supermarkets, shopping centres or travelling on escalators can provoke imbalance or dizziness.  In this case tailored visual exercises can be given to desensitise the visual system, thus decreasing symptoms.  VRT involves the active participation of the patient in a home exercise programme along with gradual increase of functional activities.  These are then progressed as tolerated.  Patient progression is subjectively and objectively monitored with the average duration of a VRT programme ranging from 4 to 10 weeks.

2 TOP TIPS FOR VESTIBULAR MIGRAINE SUFFERERS:

  1. AVOID MIGRAINE TRIGGERS
  2. MOVE

 

This information was submitted by Sheila Barrett, a Chartered Physiotherapist who specialises in the treatment of vestibular disorders and migraine. She operates from the East Cork Physiotherapy, Balance and Acupuncture Clinic, Midleton, Co. Cork.  

COULD YOU HAVE A VESTIBULAR DISORDER?

16th January 2017

Most people associate migraine with severe head pain and a period of incapacitation.  However, a large portion of people with migraine don’t have accompanying pain, their predominant symptoms instead being vertigo (a spinning sensation), dizziness, disequilibrium (loss of balance), disorientation, visual distortion or altered visual clarity.  This presentation may result in a visit to A & E, a multitude of medical professional consultations and extensive laboratory, imaging and other diagnostic evaluations – often with normal results which lends to increased confusion and anxiety on the part of the patient.  In addition, vestibular suppressant medications are often given, increasing postural instability and further compounding the situation.  Without a diagnosis, but with persisting symptoms, patients become disillusioned and hopeless.  Some patients are given a diagnosis of ‘vertigo’ which is in fact a symptom – not a disorder.  That’s why many people with these symptoms can go undiagnosed for several years incorrectly thinking that their only choice is to live with it. Like any condition, accurate diagnosis is the essential starting point and so once these patients are diagnosed with Vestibular Migraine, they can then be successfully managed.

What is Vestibular Migraine?

The vestibular system includes the parts of the inner ear and brain that process sensory information involved in controlling balance and eye movements.  Migraine is a complex neurological disorder which weakens the vestibular system causing a disruption in its functioning and results in the vestibular disorder. Vestibular Migraine is also known as migraine vestibulopathy, migraine associated vertigo or migraine related dizziness. Approximately 40% of migraine patients have some accompanying symptoms involving disruption in their balance and/or dizziness at one time or another.  These symptoms can be prior to, during, after or totally independent of the migraine event.  More detailed information can be found on www.vestibular.org

Who gets it and why?

Just as migraine can be inherited, so too can Vestibular Migraine, giving rise to a family vulnerability to this disorder.   “Often my Vestibular Migraine patients report a family history of migraine but on some occasions there is only a family history of ‘vertigo’ stemming from misdiagnosed Vestibular Migraine” says Sheila Barrett.

Causes?

The known migraine triggers such as certain foods and environmental, emotional and hormonal changes can also trigger Vestibular Migraine.    More details of migraine triggers can be accessed from this website here. 

Symptoms?

On clinical presentation sufferers report symptoms that may include – but are not limited to the following:

  • vertigo (illusionary spinning of the environment),
  • dizziness (spinning or light headedness inside the head),
  • disequilibrium (off balance),
  • photophobia (light sensitivity, always liking to wear sunglasses and disliking fluorescent lights),
  • phonophobia (sound sensitivity),
  • motion sensitivity (may feel nauseous when travelling in a car but very often the sufferer may only have a history of being a ‘poor traveller’ as a child in the back of a car and may no longer be motion sensitive as they now drive their own car),
  • increased dizziness with head movements, neck stiffness and ache (which can be as a result of holding their neck rigid in order to avoid provoking dizziness)
  • ‘muzzy’ head causing poor cognitive function (a most distressing symptom when trying to work or study for an exam)

Patients can often suffer anxiety and depression as a result of enduring some or all the preceding symptoms without clear diagnosis and treatment options.

How is it diagnosed?

There is no single test to diagnose Vestibular Migraine. Diagnosis is based on medical history and by performing appropriate tests to rule out other causes of symptoms.  One such test is functional vestibular testing using infra-red goggles.

How is it treated?

Successful management of Vestibular Migraine has to be two fold, as its name would suggest.  Firstly, the patient should learn to identify and manage their migraine triggers, just as with any migraine condition.  Secondly they must strengthen and rehabilitate the vestibular weakness with vestibular rehabilitation therapy (VRT) from a qualified vestibular physiotherapist.

What is vestibular rehabilitation therapy?

Many research studies have scientifically proven that patients with Vestibular Migraine improve with VRT.  Sufferers usually avoid head movements, moving ‘en bloc’ by holding their neck rigid to avoid provoking dizziness and imbalance.  They may limit activities such as avoiding playing sport, shopping, socialising and many adopt a sedentary lifestyle for fear of aggravating symptoms.  In doing so they are further weakening their vestibular system and in fact it is the exact opposite they should be doing.  They need to move in order to strengthen the vestibular system.  The rational for movement is based on the scientific proof that head movements which provoke the patient’s dizziness play an important role in hastening the recovery process.  However, you cannot simply tell a dizzy patient to ‘MOVE’, it has to be in a systematically, progressive manner.  This is where VRT comes in which is a systematic exercise based programme. Tailored exercises which include very specific head and eye movements which provoke symptoms of dizziness in a mild and controlled manner.  These de-sensitise and / or promote re-calibration of the vestibular system.

Other patients with migraine associated vertigo become very visually sensitive (visual vertigo) where busy visual environments such as supermarkets, shopping centres or travelling on escalators can provoke imbalance or dizziness.  In this case tailored visual exercises can be given to desensitise the visual system, thus decreasing symptoms.  VRT involves the active participation of the patient in a home exercise programme along with gradual increase of functional activities.  These are then progressed as tolerated.  Patient progression is subjectively and objectively monitored with the average duration of a VRT programme ranging from 4 to 10 weeks.

2 TOP TIPS FOR VESTIBULAR MIGRAINE SUFFERERS:

  1. AVOID MIGRAINE TRIGGERS
  2. MOVE

 

This information was submitted by Sheila Barrett, a Chartered Physiotherapist who specialises in the treatment of vestibular disorders and migraine. She operates from the East Cork Physiotherapy, Balance and Acupuncture Clinic, Midleton, Co. Cork.