Relief from vestibular migraine through physiotherapy is a journey that begins with understanding its specialized approach. Vestibular physiotherapy, an exercise-based therapy, targets persistent vestibular symptoms, such as vertigo and imbalance, following migraine attacks. Tailored exercises aim to restore stability and alleviate symptoms, offering a promising complement to medication. Learn more about what to expect from vestibular physiotherapy, its effectiveness, and how it can enhance your quality of life.
What is vestibular physiotherapy?
Vestibular rehabilitation is an exercise-based therapy that targets vestibular symptoms persisting between episodes of vestibular migraine. For instance, if vertigo or imbalance continues after the migraine attack, exercises can improve steadiness and alleviate vertigo.
I have been referred to vestibular physiotherapy. What should I expect during the evaluation?
The evaluation begins with a questionnaire covering symptoms, medical history, medications, and prior test results. Additionally, an assessment is conducted to determine how vestibular factors contribute to your symptoms during head and body movements. Balance evaluation is also part of the routine evaluation for vestibular migraine. The evaluation is tailored according to your clinical history and symptoms, with careful consideration to avoid excessive symptom provocation. A crucial aspect of the evaluation involves assisting you in setting achievable goals and devising a treatment plan.
Can any physiotherapist do vestibular physiotherapy?
It’s important to seek out a physiotherapist with specific training in vestibular rehabilitation. Physiotherapists who specialize in this area typically have a keen interest in vestibular rehabilitation and have completed specific courses during their professional development.
Should I undergo evaluation during a migraine attack?
During an acute attack, the goal is to remain calm and minimize unnecessary movements, similar to managing a regular migraine, while attempting to alleviate symptoms promptly, if possible. Conducting an evaluation during this time is likely to be unproductive, poorly tolerated, and not useful, as the diagnosis of vestibular migraine primarily relies on medical history rather than current symptoms.
What types of problems can be treated with vestibular physiotherapy?
Vestibular physiotherapy is effective in treating balance issues such as dizziness in busy, complex, or visually contrasting environments, as well as positional vertigo. However, symptoms such as constant imbalance, discomfort, or nausea triggered by head or body movements may have less favourable outcomes.
How does vestibular physiotherapy work?
Vestibular physiotherapy works by selecting exercises tailored to engage different areas of the brain. These exercises aim to re-establish neuronal connections and mitigate abnormal brain responses to restore effective vestibular reflexes and pathways that may have been disregarded or are currently ineffective.
If I have vestibular migraine, will vestibular physiotherapy help me?
Vestibular physiotherapy typically plays a crucial role in managing residual symptoms once medications to reduce or control vestibular migraine attacks are optimized. The success of physiotherapy depends on your level of autonomic sensitivity (i.e., how easily you experience symptoms like nausea or dizziness in response to triggers or movements) and your overall tolerance for physical activity.
What types of exercises are used for vestibular migraine?
Various exercises can be tailored to meet your specific goals:
- Balance exercises aim to reduce instability and dizziness.
- Habituation exercises aim to decrease positional vertigo and dizziness related to sensitivity to head movements.
- Specific maneuvers for benign paroxysmal positional vertigo (BPPV), which is often associated with vestibular migraine
- Visual exercises using movements of the eyes (oculomotor exercises)
How long should I continue exercises before seeing improvements?
The timeframe for improvement varies significantly depending on the symptoms being treated. For instance, positional vertigo often improves within a few treatment sessions, whereas balance improvements with a home-based program may take several weeks. Individuals with vestibular migraine typically require more time to see improvement compared to those without migraine because their brains may not “habituate” as quickly to the exercises.
Will I need to do these exercises for the rest of my life?
Typically, these exercises are continued only if symptoms do not return to their baseline level between episodes of vestibular migraine. Once symptoms have returned to normal, ongoing exercises are usually unnecessary. However, some individuals may benefit from practicing them a few times a week for maintenance.
I’m often told that anxiety makes dizziness worse. Is this true, and what can I do about it?
Yes, anxiety exacerbates many symptoms, including dizziness. The best approach to managing anxiety is to utilize techniques that have been effective for you in reducing stress in other areas of your life. One common factor that can increase vertigo, dizziness, unsteadiness, and nausea during periods of stress is changes in breathing patterns, such as faster and shallower breathing. These changes can intensify symptoms. It’s beneficial to learn to recognize these patterns in yourself. Breathing exercises can be particularly helpful in managing anxiety-related symptoms.
In summary, vestibular physiotherapy can be highly beneficial if you are living with vestibular migraine. While it may require dedication and time, the long-term benefits can be significant.
References
- Alghadir A, Anwer S. Effects of vestibular rehabilitation in the management of a vestibular migraine: A review. Front Neurol. 9 440. 2018.
- Sugaya N, Arai M, Goto F. Is the headache in patients with vestibular migraine attenuated by vestibular rehabilitation ? Front Neurol. Avril 2017.
- Vitkovic J, Winoto A, Rance et al. Vestibular rehabilitation outcomes in patients with and without vestibular migraine. J Neurol. Vol 260, pp. 3039-3048. 2013.
- Gottshall, KR., Moore, RJ., Hoffer, ME. Vestibular Rehabilitation for Migraine-Associated Dizziness. International Tinnitus Journal. Vol. 11, No. 1. P. 81-88. 2005.
- Wrisley DM, Whitney SL, Furman JM. Vestibular rehabilitation outcomes in patients with a history of migraine. Neurology Report. Vol. 24, No. 5, pp. 178. 2000
- Whitney S Wrisley D Brown K Furman J. Physical therapy for migraine-related vestibulopathy and vestibular dysfunction with a history of migraine. Laryngoscope. Vol 110 pp. 1528-1534. 2000
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