VRT and MAV – any use?

Hi All,

Here’s the paper that showed that in some migraineurs, VRT was effective. Note that many of them were medicated but, curiously, not all. As I’ve often said, Steve Rauch says that when VRT exacerbates symptoms in a dizzy person and just makes them feel worse and worse, they are probably suffering with MAV. He says it is “practically diagnostic”.

http://www.glycemicindex.com/sd/VRT_migraine.png

http://www.glycemicindex.com/sd/VRT_migraine.pdf

Scott

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In summary:

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

  • 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.

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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.

Does the article mention what type of medication was taken by some of the people in the study? Given the right combo of valium and meclizine I could probably sail through VRTand score at the top of the class. But without it, I’m not even willing to give it a shot. In order to see how VRT really works for someone with MAV I think it would only be fair to remove the medications. Given that three of the four authors are physicat therapists and they want this study to show that VRT works for MAV it seems they can do what they want to skew the results in their favor.

Book

Im on amitrip at the mo and am planning to start VRT very soon they did say migraine has to be under control first before starting it but i do have quite a bit of faith in VRT its worked for others .

Donna