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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).


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.


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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I have an appointment with my neurologist next Tuesday and I was wondering whether I should ask her for a referral to VRT. I read some of the comments on this forum and it seems that VRT helps some people, but not others. I feel about 80% ok, but have an underlying dizziness and a painful neck. I am also on Pizotifen (3 x 0.5 mg).

The discussion in this topic is great, but I imagine that VRT might have changed/evolved over the last 8-10 years. I am therefore interested to know whether anyone has recently had VRT and what you thought of it. Did it help you?

Before you make an attempt do please plough through all the previous relevant threads on here. Like everything it it helps some and not others as you say. Be warned however it can make people with VM very much worse. I was one, @turnitaround was another. Go with what the specialist says. I write this with :crossed_fingers:because I’ve even heard of instances where consultants in integrated teams have recommended it only to later say when challenged over particular exercises by their patient ‘ No you shouldn’t be doing that [particular exercise]’.

I’m sure this forum could have an interesting discussion on how much VRT has changed in recent years. What I think more pertinent is where you are in the world. The US seems very good and uses it a lot with some success. The U.K. is way behind except a couple of London-based centres are right up to date with Google’s and Virtual Reality stuff of which I was very envious until I knew somebody who went through it all only to find it didn’t relate to the real world at all. In Australia I think you might be quite lucky and I say that because I think I’ve read material on it which emanated from Australia which seemed to indicate so.

Good Luck and keep us posted. Personally all I can say is as you already have a stiff neck which IMO incidentally is both symptomatic of and pretty near diagnostic of VM in its own right, it’s just as well you aren’t likely to team up with the VRT bod I had. I once calculated the exercises she gave me, practised five times daily for six months, involved some 450 head turns daily. Anybody who hadn’t had a stiff neck before they started very soon would have ….

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Thank you for your thoughtful reply @Onandon03. I spent a few hours yesterday reading through most posts on VRT - this forum is fantastic! I am in Australia and there was a positive mention of a therapist in Sydney. However, I live about 1000 km north of Sydney (on the Gold Coast) and I can’t travel there at the moment because Sydney has a covid outbreak and is in lookdown. The Gold Coast is covid-free.

This is very interesting. I always thought if I improve my neck stiffness, my dizziness will get better as well. I am doing exercises each day for about 30 minutes and some of these exercises are for the neck. I have done them for about 12 years and my body is used to them. The neck exercises are very gentle and seem to loosen it up a bit. I also do two shoulder exercises at my strength gym and again, they seem to help. But the thought of doing 450 head turns daily makes me dizzy just thinking of it.

I’ll report back what my neurologist says about VRT on Tuesday.

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Yes I noted the Sydney one and wondered. Even checked out the exact location of The Gold Coast, sorry my geography’s not much of it regarding Australia. Still if there’s an enlighten one in Sydney just maybe there’s another nearer you who went to the same school!

From experience the exact opposite is true. But then again I didn’t have an existing neck problem or any neck trauma prior to VM arriving so it could prove different for you.

The neck theories are fascinating. It can I read and it seems logical to believe from previous experience work on many levels. VRT Bod told me all exercises must be carried out with completely relaxed soft muscles otherwise you are actually teaching your brain to respond to abnormal sensitisation ie wiring it in totally the wrong direction. Trouble I’ve always found is those tight muscles result from the VM. I had no control over them. Unlike other muscles (I did Tai Chi for 4 years) I couldn’t keep relax them. I used to say it was coming from my brain, I couldn’t stop it being tight. I was given shoulder rolling exercises to do as a relaxing warm up but they would only work momentarily whilst I was symptomatic. So ultimately I was always working against tight neck muscles.

Did far worse for me I’m afraid. First time I saw VRT she told me she could put me completely right in six months but it would be hard work for me. Six months of her version of VRT and I lost my balance for a couple of months. Couldn’t stand unaided. No doubt an extreme reaction to an extreme VRT regime but I’m not the only one. There’s evidence of others with VM doing VRT on here too. I will never touch it again. Not with the proverbial barge pole.

In fairness to the VRT provider she understood from ENT that I was suffering from some unspecified peripheral vestibular disorder. I had as yet no VM diagnosis. Once I had a ‘probable’ MAV diagnosis she refused to even see me until I had the condition completely under control by medication not that I would ever go back.

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Tips For Breaking the Vicious Cycle of Dizziness

Long document. Try the last couple of pages for further info first.

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Same here. My neck muscles relax a bit after my own exercises and after a massage, but then they go back to being stiff.

That is terrible, definitely not a good sign after doing all the VRT!

Thank you for the link, will read it tonight!

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Just did a quick search in the Gold Coast. Back in Balance looks ok for vestibular therapy.

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Would this be it, the one you meant.

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Yep. Sorry didn’t do the link

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