Quick question - VRT?

Hi,

You guys have been really helpful since I joined (just a day ago) and I’ve asked a lot of questions. I have one more quick question though that I thought I should put in a seperate thread. I’ve been doing VRT almost daily for a few months now as it was thought that I had uncompensated Labs/VN. It always makes me dizzier worse when I do it for an hour or so afterwards, but sometimes I feel a little better a few hourse later. Other occasionaly it makes me far worse and I’m a lot dizzier for a few days.

While I wait to see the Doc again and to try the MAV route, do you think it is prudent for me to carry on with the vrt or to lay off it? How does VRT interact with MAV?

Mark

Hi Mark,

If it were me, I would lay off the VRT since it doesn’t seem to be helping overall. VRT typically causes worsening of symptoms for those with MAV. I haven’t tried it myself, so I am basing this on what I have read of others’ experiences.

Take care,

Marci

My completely unprofessional, not-very-knowledgeable understanding of VRT is (as Marci indicated) that if you try VRT and it makes you feel worse, that’s pretty much a sign that you DO have MAV.

Many people with MAV can’t really do much that involves (a) physical exertion or (b) visual focus / concentration. This tends to be basically too much for the brain; it’s believed that an MAV brain is hypersensitive and does not properly respond to various stimuli / input, such as motion, proprioception (sort of the body’s sense of where it “is” spatially), visually complex environments (such as grocery stores), etc.

If sometimes you feel a little better afterward, then that may or may not be as a result of VRT. It depends – does the intensity normally change / vary a little bit throughout the day?

Presumably, if VRT was helping, you’d see a trend of gradual improvement, rather than ‘sometimes better, sometimes worse’ after doing it.

In this context, I think the bottom line with MAV is, unlike people with inner-ear disorders (like VN), MAV isn’t so much a matter of helping the body learn to “compensate” as it is a matter of simply trying to help the brain resume normal functioning. Once the migraine loop “stops,” so should the symptoms.

As I understand it – and I could be wrong – MAV doesn’t originate in the vestibular system (though it can affect it); rather, migraine is “a global disturbance of sensory signal processing,” and is neurological, not vestibular – which is why the best treatments seem to be those that directly affect the functioning of the brain rather than the body’s balance system.

… Remind me never to try to explain things again; I stink at it.

Hi George,

A very good explanation. Thanks for that. You hit a lot of good points to. I suppose you’re right, I should now switch from bombarding my brain with sensation to compensate for VN, to just keeping quietely busy to get my brain to resume normal activity.

It is hard to switch my behaviour though after most of a year of (I thought) fighting VN, which I now am beginning to think I don’t have. I’m so frustrated if I have been misdiagnosed all this time, but then getting the correct diagnosis and finding the correct treatment is the main thing.

So many things with my VN diagnosis didn’t fit now I think about it and the Doctors should have noticed them:

  1. The dizziness came on gradually over a couple of months, rather than suddenly
  2. No Nystagmus
  3. No inflamation in my ears
  4. No hearing loss or tinitus
  5. No worse in the dark. In fact slightly better. Labs/VN sufferers are supposed to feel dizzier when there is low light

Does MAV usually have accompanying anxiety by the way? I have felt in a heigtened state of anxiety ever since getting this condition. Kind of butterflies in my stomach for no particular reason.

Mark

— Begin quote from "MarkSD"

Does MAV usually have accompanying anxiety by the way? I have felt in a heigtened state of anxiety ever since getting this condition. Kind of butterflies in my stomach for no particular reason.

— End quote

Yes, anxiety at some level is VERY common with MAV.

Hi again Mark –

“Keeping quietly busy” is an OK idea – though let me clarify that I’m not sure it actually HELPS the brain return to normal. I think the idea is just that you do whatever feels comfortable – including taking it easy … and not feeling guilty about doing so. Because there’s no point in “pushing yourself” – it won’t make you better, and it probably won’t hurt you in the long run, but it’ll make you feel crummy in the short-term. I’ve had more time than usual spent just sitting down with the TV on, or by the computer, etc., because those activities aren’t too bad.

It is hard to switch behaviors, especially when you’ve been doing them for a long time. As for VN, yes, that was what I was misdiagnosed with too. As soon as some folks helped point out that it was completely wrong, I figured, “Different diagnosis means different way of dealing with it.” Of course you’ll want to get formal confirmation from a doctor that you have MAV, but I can’t imagine it being something else.

Gradual dizziness – this happens with some people, though in my case, it was very much a sudden thing. (Actually, though, I’d like to get Scott’s input on this – the whole gradual vs. sudden thing. I’m not sure I understand how this factors into the normal “introduction” of inner-ear dizzies vs. MAV.) I was at the computer and out of the blue I started feeling lightheaded. No nystagmus = MAV can present with or without it, though it’s usually minimal if there is any. No inflammation, hearing loss or tinnitus rules out labyrinthitis and a number of other ear-related things.

Better in the dark = Yes, me too, again. That’s because this isn’t ultimately a problem of balance; it’s a problem of visual input. Ergo, the less visual input to deal with, the less “confusion” for the brain to deal with.

By the way, how’s your balance? If you’re not actually off-balance (e.g., you don’t fall, and you don’t feel like you’re going to), that points to MAV too. Inner-ear things like VN affect the actual ability to balance.

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Hi again Mark –

By the way, how’s your balance? If you’re not actually off-balance (e.g., you don’t fall, and you don’t feel like you’re going to), that points to MAV too. Inner-ear things like VN affect the actual ability to balance.

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Despite feeling dizzy, my actual balance is ok. I can stand on one leg with my eyes closed for a long time at least and it doesn’t make me feel worse to do so.

Changing my behaviour is going to be hard. The thing is, I work for myself (a small, but busy IT company) and I have always been an outdoors, fitness enthusiast. Hopefully there is some med I can take which will mean that I can still go to the gym and be reasonably active (but without the dizziness). I don’t want to have to retreat into my home.

Mark

If visual dependence is your main problem (e.g., visually complex environments, moving around, etc.), Dr. Hain says he favors Effexor (venlafaxine) because he finds it particularly useful in patients with that symptom. You might mention that to your doctor. (Some discussion of the symptom here: dizziness-and-balance.com/di … visual.htm)

But, that’s a call your doctor will have to make. And like all the other MAV medicines, unfortunately, Effexor works for some people and not for others.

Hi Mark,

For the most part it appears that VRT is a waste of time when migraine is interfering. Dr Rauch of course states that when VRT fails, it is usually diagnostic for MAV. And this makes perfect sense. How can VRT work you would think when there is some neurological process undermining everything all the time?

But here’s a study that throws a small spanner into this thinking. Although 56% were taking a migraine med, there was still improvement in those not taking a med. Surprisingly, just 4 felt worse doing VRT. Personally, I think if it makes you feel worse, then you should stop until you get the migraine under control first. Then you can do some VRT if you feel it’s needed.

[size=130]Physical Therapy for Migraine-Related Vestibulopathy (MRV) and Vestibular Dysfunction With History of Migraine[/size]
SL Whitney et al.
Laryngoscope. 2000 Sep;110(9):1528-34.

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–– Persons who experience migraine-related vestibulopathies often have abnormal vestibular laboratory results (interestingly Joe’s recent neurologist didn’t have a clue about this!).

–– the diagnosis of MRV 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 MRV.

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

–– 39 patients were identified through a retrospective chart review, 14 with a diagnosis of MRV 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 MRV 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. Twenty-two of the 39 patients were taking meds that might affect the severity and frequency of migraine and 17 were taking no medication.

–– 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 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.

–– 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 MRV. Also, a history of migraine should not be considered a contraindication to a trial of physical therapy.

— End quote

Scott 8)

http://www.mvertigo.org/articles/physical_therapy_MAV2000.pdf

— Begin quote from "georgekoch"

If visual dependence is your main problem (e.g., visually complex environments, moving around, etc.), Dr. Hain says he favors Effexor (venlafaxine) because he finds it particularly useful in patients with that symptom. You might mention that to your doctor. (Some discussion of the symptom here: dizziness-and-balance.com/di … visual.htm)

— End quote

Its not visual disturbances that bother me. It’s dizziness and disequilibrium. That is by far my most dominant symtom. I feel basicaly like I’m really sea sick/car sick all the time. Together with an accompanying anxiety.

Mark