Interesting case study

books.google.com/books?id=tLNcGz … q=&f=false

thought this was interesting. However, I am confused by the authors recommendation of VRT, which I still remain perplexed about (most docs told me that medication with take away all migraine symptoms without the need for VRT). still a good read.

Hi Lisa,
I’m not sure if you noticed, but the author of this case study is the same Dr. Furman I was referring to in our previous post. With regards to VRT, most docs and therapists say it is patient specific. There is another study that I know of that absolutely showed efficacy in using VRT with MAV. If the patient gets much worse with it, VRT is contraindicated until medication stabilizes things a bit. However, I still believe the only thing that is gonna knock out MAV is meds… especially those of us suffering as badly as you and I.
Best,
Lisa

Yes, I did notice that Furman was among the authors. Forgot to mention that. I think you are right about us needing meds. We have seen many success stories of people getting well without VRT.

Hi Ladies,

Thought I would chime in here, I for one am going to give the VRT a go. I am stabilized a bit for now (I think) the propranolol is helping me with some of the anxiety which seems to be a trigger for me. I do have a slight left ear issue so maybe it will help. It’s something to hope for if nothing else. Do either of you have any ear troubles? Mine hurt quite often, especially during a bad headache.

Have either of you tried it? and for how long?

Tammy

Hi Tammy,
I have been doing VRT 3x/day for over a year now. I wasn’t diagnosed with MAV until 3 months ago and my neurologist left it up to me to continue or not at that point. He did not feel strongly one way or the other and. It will not help with my rocking, but perhaps it helps with my motion sensitivity. Part of why I continue to do VRT is that it gives me some hope and makes me feel that I am doing someting towards my recovery. It does not make me feel more ill and that is very important when determining whether someone should do VRT. My life is quite limited in my ability to go or do much, so I certainly have the time to get all three sessions in a day, 7 days a week. :?
Good luck,
lisa

There is indeed a study about this I posted on another forum in 2007. Lisa – very good find! Thanks for the case study link.

[size=150]Physical Therapy for Migraine-Related Vestibulopathy and Vestibular Dysfunction With History of Migraine[/size]
SL Whitney et al.
Laryngoscope. 2000 Sep;110(9):1528-34.

http://www.glycemicindex.com/sd/physio_migraine-related_vestibulopathy.pdf

In summary:

Note: They use the term MAV here for people experiencing vertigo without the headache component.

— Begin quote from ____

  • Persons who experience migraine-related vestibulopathies often have abnormal vestibular laboratory results.

  • the diagnosis of MAV is often a diagnosis of exclusion after other vestibular and central nervous system diseases have been ruled out. Use of medication and control of dietary triggers is often helpful in the control of MAV.

  • The purpose of this retrospective chart review was to determine the efficacy of physical therapy for patients with a diagnosis of MAV and migraine headache. There is no evidence in the literature that persons with MAV and migraine headache improve functionally with physical therapy intervention.

  • 39 patients were identified through a retrospective chart review, 14 with a diagnosis of MAV and 25 with migraine headache. The patients were treated with a custom-designed physical therapy exercise program for a mean of 4.9 visits over a mean duration of 4 months.

  • Abnormal caloric responses were demonstrated by 55% of the patients, rotational vestibular test results were abnormal in 42% of the patients, oculomotor test results were abnormal in 29% of the patients, and positional test results were abnormal in 19% of the patients.

  • Significant differences were seen after therapy in each of the outcome measures used. Patients with MAV and migraine headache demonstrated improvement in physical performance measures and self perceived abilities after vestibular physical therapy.

  • There appears to be an improved outcome if a patient is taking an antimigraine medication in conjunction with physical therapy intervention. Only four of 39 patients referred for physical therapy were worse after intervention. After performing this retrospective study, the authors believe that physical therapy should be considered an efficacious treatment for patients with MAV. Also, a history of migraine should not be considered a contraindication to a trial of physical therapy.

— End quote

— Begin quote from ____

Twenty-two of the 39 patients were taking medications that might affect the severity and frequency of migraines and 17 patients were taking no antimigraine medications.

The group taking medication demonstrated higher composite scores at both initial evaluation and discharge than did the group not taking medication. Subjects in the group taking medication demonstrated lower DHI scores and higher DGI scores at discharge (indicating less impairment) than did the non-medicated group. The amount of change in the outcome measures before and after therapy was not statistically different between the two groups.

Of the patients with a diagnosis of migraine-related vestibulopathy (MRV), 7 were receiving medication and 7 had not received medication. The MRV group that received medication demonstrated differences that approached statistical significance in discharge composite score from the group not taking medication. In the migraine headache group, 15 were receiving medication and 10 had not received medication. No significant difference or trends in outcome measures were observed between the patients receiving or not receiving medication in the group with a history of migraine.

— End quote

Scott :slight_smile:

Just a sidebar here. Dr. Furman is my main doctor treating me. He too suggested VRT to me after some time. It was secondary though to the use of medications. I decided on my own not to go that route, as I felt it would not benefit me, as the medications were helping me a great deal and my balance issues were not that bad to begin with. I would note also that I do not have some of the issues that others here have (inner ear damage or disease), thus my situation is a little different. I agree that VRT may or may not be helpful to people, but meds definitely are. I got that impression from him. I have not yet had a chance to look over this book so I can’t comment on that directly, but I do know that Dr. Furman is a top neurologist in the area of balance disorders and deals with MAV. He knows more about the balance side than migraines per say, however, thus why he referred me to another neurologist at Pitt’s headache clinic who deals specifically with migraines. The two of them are treating me now.

I went to RUSK at New York University for a few sessions. The director there actually told me that they have little success with MAV pts, and I eventually stopped. However, who knows? I think if my migraines were better controlled maybe it would be a little helpful.
Lisa - I can understand you wanting to continue. It does make you feel like you have some more control over getting better.
bcrelief - what meds did Furman put you on?

Lisa - Dr. Furman did suggest Zoloft and similar meds, but since I had used them in the past (for other reasons) and did not like the side effects, we did not go that route. He put me on Klonopin which I am still on (and like a lot) and then also Tofranil which I am also still on. These two are for the balance issues. I may try going off the Tofranil after I figure out what I am doing with the migraine med. I am currently trialing Topamax with my other doc for the migraine issues.

bcrelief - so confusing. it seems like Dr Furman thinks that the dizziness is separate from the migraine?? Does he believe that the migraine caused vestibular damage? I went to one doc who took that approach; however, other docs strongly believed that the migraine hasn’t caused damage, and this all needs to be treated as a migraine.

Lisa, no, I don’t think he sees them as different necessarily, but that different meds work for different areas. I don’t know how to explain it because I don’t totally understand it myself. He definitely believes in MAV and treating MAV, but I think one’s treatment may vary depending on the symptoms.

Hey Scott,
As always thanks for posting this paper. How are you feeling? Any positive movement?

I think with regards to MAV and VRT, the consensus is that if you are very dysfunctional meds will be required and there is a potential for VRT to move things along. This is probably why docs that treat MAV don’t push VRT on patients and instead encourage the use of meds if a patient is in very bad shape. I have definitely noticed that if I skip a day or two of my VRT exercises as I have in the past, my motion sensitivity increases and the exercises make me more uncomfortable and are harder than if I am consistent with them. This is only my experience and certainly not proof that VRT works. So, for me, VRT did not give me enough improvement on it’s own (I was doing it for at least 9 months prior to my MAV diagnosis) but I am hoping that the meds will take me to higher level of functionality.

Best,
Lisa

Lisa - what you wrote about VRT definitely makes sense. Did you go somewhere to learn the exercises or are you doing them on your own based on your own research, etc? You are working so hard to get better. I just know that you will get better - you sound like such a fighter and you will beat this illness!

Thanks Scott,

This gives me the incentive I need to continue with both VRT and meds. I got absolutely nowhere with VRT alone, the headache it gave me was awful. If nothing else ( like Lisa) it gives me something to do to help myself.

How are you? Rested and better I hope!

Tammy

Hi Lisa,
I see this teriffic guy who recently left Rusk to work in a private practice physical therapy setting. I think he was at rusk for at least 5 or more years. He did graduate work in vestib. therapy with Sue Whitney (the author of Scott’s most recent paper he posted) and Dr. Furman at the Univ. of Pittsburgh. He was actually the one who eventually prompted me to see Newman to rule out or rule in MAV. He is a big proponent of VRT for MAV and has worked with a number at Rusk as well as in private practice. He does however believe meds are necessary for complete resolution of symptoms. I am lucky that my insurance covers 100% of my visits so I do see him 2x per week. He works on my neck at the beginning of our sessions as well (I also have neck pain) and I think psychologically it is good for me to talk to him…and it gives me a place to go that I can tolerate 2x/week. I don’t get out much these days…lol.

If my insurance were not covering this in full, then I would probably go about 1x per month. I do the exercises at home 3x per day 7days a week.

Thanks for your positive thoughts. I know you will get better too and have a wonderful addition to your family to enjoy!
Warmest,
Lisa

Hi Lisa and everyone else… the following was written by my Vestibular Therapist and I wanted to share with everyone in response to Lisa being told that VRT could not help her. He really is a very thoughtful, super-knowledgable guy who worked years at Rusk (see my post above). Hope this is a bit helpful:

“I’m sure they said they had little success with MAV for patients who are not on medication. As we’ve discussed, the patients with MAV (not on medication) seem to either slowly get better with the exercises or get much worse. Many of those that do get better seem to have an improvement only for as long as they keep doing the exercises. For something like a neuritis, once you feel better you can stop the exercises because your brain has adapted, but for MAV, it seems that if you stop the exercises many people start to feel worse again. In your case you feel crappy all the time, like a lot of MAV patients do, but you are not nearly as symptomatic with the vestibular exercises as most people are that I have seen with MAV. Most doctors and therapists that work with MAV think that vestibular rehab helps, and I think it helps, but I strongly believe medication is also needed to really fully get rid of the symptoms.”

Thanks for that, Lisa. That is wonderful that your insurance covers it, and I’m sure it’s good for your spirits to do something productive during the week and have some human interaction with the physical therapist. I’m sure it cannot hurt, and seems like it will help in concert with meds.