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To VRT or not to VRT?

Hi all…Dr S said to me that VRT exercises are useful for dizziness (no matter what the cause) but only when the dizziness is stable…I have huge fluctuations in symptoms so I’m very cautious to do even the simple exercises at home…I’ve heard some people say VRT is contraindicate full stop for MAV…anyone happy to share experiences or thoughts?? Thank u. X

I have done daily VRT exercises for years and apart from making me feeling dizzier whilst I do them and for a few minutes afterwards I can honestly say that they haven’t appeared to do anything really. They don’t seem to make me worse or better overall. There is no noticeable change either way for me x

Hi ladies, yes your rights dr S recommends once your stable. Lizzie has he given you some exercises yet? I think if Dr S / N Harris hands them out it’s best to do them. I know both myself & Rob do them xxx

i tried vrt (when mav not stable- still isn’t) and for me it was completely worthless. for some reason 4 weeks in my balance got much worse and has stayed worse- I don’t blame vrt for that though- just saying for me it did nothing. it didnt make me that dizzy either.

I did it for 3 months and it made no difference except for freeing up my neck a bit. The physio discharged me as she felt the dizziness was unstable and equally as much internally generated as positional. The interference was too great. If it ever died down a bit with meds I would give it another go. It doesn’t hurt to try and cartainly made me no worse.

Hi guys,

In a past email conversation, Prof Steve Rauch once told me that when VRT exacerbates symptoms in a dizzy person and just makes them feel worse and worse, they are probably suffering with VM. He says it is “practically diagnostic”. And this from his contribution to the forum under FAQs answered by neurologists.

Note: Steve may not have had access to the full paper below that he cites (I’m sending it to him now). The abstract on PubMed does not make it clear that many of the responders to VRT were taking migraine medicines. I’ll link to the full paper later today.

— Begin quote from ____

In summary:

Note: It appears they use the term “migraine-related vertigo” (MRV) here for people experiencing vertigo without the headache component.

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

  • 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. 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

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.

[size=130]On Vestibular Rehabilitation Therapy (VRT)[/size]

My general experience is that most migraineurs cannot tolerate vestibular rehab until their migraine is under control. If they try VRT first, they usually quit after the second session because it makes them feel so ill. That said, Sue Whitney at Univ of Pittsburgh has research suggesting that there is VRT benefit in migraine.

As you well know, balance differs from all other senses in that all the other senses depend on only a single “flavor” of sensory input, while balance depends upon integration of multiple sensory channels (labyrinth, vision, somatosensory, etc). Since migraine screws up the calibration of sensory signal processing, sensory integration is deranged. I believe this is best operational definition of the balance disturbances seen in VM – a disturbance of sensory integration. If this model is correct, one would predict that VRT will not work until the sensory signals can be stabilised enough to allow for relearning of the integrative tasks (or for the signals to revert to their pre-migraine calibration).

Steve


Steven D. Rauch, MD
Director, MEEI Balance Center
Professor, Otology & Laryngology
Harvard Medical School
Mass. Eye & Ear Infirmary

That kinda makes me feel better because i have had no official diagnosis but strongly suspect i have VM, i have tried VRT on a number of occasions and within 2-3 days i feel much worse and give up so that does suggest i do have VM.

I’ve had a mixed experience of VRT. Once it really helped a lot, but other times it just made me worse. The difference between the times was that I was in a really good stable spell the time it worked, and the other times I wasn’t. So I guess my experience reflects the advice ofDr Rauch in that it’s not a good idea until the migraine is under good control.

I’ve had mixed results too.

But I’ll tell you this: if I remember right, VRT makes me feel worse quickly, so I don’t have to struggle through a long period of efforting in order to find out that now is not a good time.

Hi

I did VRT religiously for 6 months desperately hoping that it would cure the dizzies. I did crazy spinning and balance exercises three times a day as well as visual exercises where I would scan my eyes across a checkered image. I’m afraid that it did not help me at all even after all the work I put into it. It in fact made me feel worse and would take me a good hour to get back to my baseline.

Here’s the Poll:

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