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.
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