What's working for me -- turning the corner with integrated comprehensive treatment

First – let me preface this post with a disclaimer and a warning to posterity if you’re currently in the thick of this. This disease is a beast. It will push you further and farther than you’ve ever been pushed before and then some, and it is NOT all in your head. Chronic migraine is the most severe chronic headache phenotype, and chronic vestibular migraine is its insidious sister disease that lurks off in the shadows. Because this is an invisible illness, it may seem like the most rational thing to do, and maybe the only thing you CAN do in this particular situation, is to ignore it and pray that it will go away, but I would strongly discourage this approach. This disease demands your respect and it demands that it be taken seriously and only then will it finally begin to let go and relent.

That being said, I came into this forum with a number of misconceptions and harbored prejudices about migraine that ultimately significantly impeded me getting on the path to recovery. Among these was an idea that “migraine” is a singular collection of symptoms and not a spectrum of disease with many different flavors and variants. Another was that “Migraine can’t be that bad because everyone has it” and that “everyone gets migraines” as this is a logical fallacy that disregards the heterogeneity of migraine disease.

The worst of these misconceptions was that I was doing something wrong, or there was something that I could do naturally to self-treat my illness through the use of supplements, over the counter medications, candida cleanses – it’s all pseudoscience and wishful thinking. Do not go down this route – it will only delay the inevitable of you either getting worse or needing more intensive treatment than you otherwise would have needed. Serious diseases require serious medical intervention or at least advice from someone with a degree, and believe me when I say that this is certainly a serious disease. This is a tough truth that may be difficult for some people to read, but you do not know better than your doctors. Please listen to them and cast aside your distrust. Sometimes it really is “just migraine”, whatever that means. It does not take away from the seriousness of the disorder. I really wish someone had conveyed this to me when I was early in my journey, but I had to figure it out the hard way, and I paid the price with interest.

This idea carries through with medications. People with this disease tend to be highly intelligent, but neurotic (I’m sorry but its true). This can manifest in overanalyzing our body’s responses to particular medications resulting in us casting them off sooner than they should be in order to determine if they’re effective or not. If you are assigned a medication; stick with it until you have very good reason not to (serious side effects, lack of efficacy after 3 months, etc). I have been guilty of stopping medications far, far too early because they “make me feel funny” or cause a side effect that’s uncomfortable but not dangerous. This is a barrier to recovery – sticking with a medication until I had a good reason not to was the BEDROCK of my recovery progress. There are no bad drugs; there are drugs that work and drugs that don’t. People react differently to different medications so please do not read the Drugs.com reviews for your medications and instead give them a fighting chance. My drug is Venlafaxine, and if I had seriously believed even a fraction of the horror stories and that they would apply to me, I wouldn’t be writing this “success” story.

The biggest barrier it seems to me in getting better from this is education. Because VM is a more rare subtype of chronic migraine, many physicians do not know how to properly advise patients with it, and this fuels frustration and a certain degree of doubt in patients.

Now onto my recovery plan and what worked and what didn’t:
Like I said, this disease demands your respect and it demands your attention. That being said, for many of us, its not enough to just do one thing: diet, exercise, medication, supplements. In many cases it requires a combination of different things.

Things in order of importance:

  1. A preventative – like I said, for me it was Venlafaxine 37.5 mg and then 75mg which is my current dose. You have to try different medications for multiple months before you make a final determination regarding whether or not they work for you. For me, it took about 2 months to be absolutely sure that it was doing something and another month and a dose increase for me to have sustained relief and a significant reduction in the number of my attacks
  2. A diet change. I followed the heal your headache diet which emphasizes the elimination of tyramine producing foods. There is a kind of compounding effect that happens with the diet, where at first, the effects are barely noticeable, but the longer and longer you’re on it, the more pronounced the positive effects are. My biggest triggers were coffee, cheese, onions, and gluten. It sucked eliminating them, but feeling good is better than cheese. I’m sorry but it just is! It took 3 months for this to make any kind of difference.
  3. Supplements. Magnesium, Niacin, and Fish Oil were what I started with, but they had little effect. I recently added in high dose Carnitine and the effects were DRASTIC. I havent been on it long enough to say if its truly the carnitine or other measures starting to make dividends, but I’ve been on it for about a week and my baseline day-to-day dizziness dropped down to 0.
  4. Resting and shifting my perspective about migraine: I’m a big proponent of the underlying metabolic theory regarding migraine, in which migraine is a process that gets triggered when there isn’t enough cerebral energy to go around. That being said, migraine in that perspective is the brain telling you to REST. Allowing myself to do this and forgiving myself for it was what marked my transition from chronic to episodic disease
  5. Exercise – I need to get better about this, but walking and mild aerobic exercise helps a lot, but I can’t imagine it would do much in the absence of everything else.

Where am I now? I have grown to dislike the “% better” indicator for how I’m doing with this disease because its difficult to objectively quantify. Its better to rationalize in terms of function: what can/can’t I do now, and how has it changed over the course of my treatment? I can now do basically everything that I could do before my illness. I can use the computer, I can go out for the day without getting slammed with dizziness halfway though, I can go shopping at the grocery store with mild discomfort, I can work, be productive, and follow my passions as I did before.

Where do we still have to get to? The more subtle things. I still get attacks but they’re more brief. They’re normally weekly disturbances of mild dizziness that I sleep off. I still have heavy postdrome that takes a while to clear up and I suspect it will be a lot longer until it’s gotten rid of: brain fog, dissociation, memory disturbances, etc. Hopefully in the coming weeks and months, this will get straightened out.

Success, but definitely not done, “cured”, in “remission” or the like. I’ve found something that works and we’re moving in the right direction. I suspect that this is a lifelong disease – I have no expectation that this is all just going to go away and never come back. I’ve already been though the 5 stages of grief in emotionally processing all that. However, I do believe that this is entirely possible to manage just as people manage headaches that come and go and high blood pressure, and the like.

Let me know if you have any questions :slight_smile:


Great post, thank you!

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Glad you’re feeling better. I used to feel that i was doing something wrong because i couldn’t find triggers, and if i couldn’t avoid them how was i goong to get better? All the basic things like diet, sleep, exercise just don’t work for me. I learned to give up obsessing over triggers and cause, migraine just isn’t understood well enough to have all the answers.

I have to agree with you about exercise - despite people repeatedly stressing movement/activity is essential, on it’s own and without successful preventative meds, it does nothing for me but make me worse.

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i think the key with the exercise is the consistency, which is difficult given the waxing and waning of VM symptoms. I haven’t yet been able to pull it off.

i imagine strength training/weights might actually be better for VM than low intensity aerobic exercise, but thats just conjecture/unscientific guesswork.


Great to hear you are doing better! I feel like we’ve followed a very similar timeline of progress in this. I second the philosophy of VM you’ve laid out here. There is no magic bullet but a requirement to foster a migraine friendly environment in your life (both physically and psychologically). I’ve been holding on to the phrase “Don’t let you world get smaller,” someone may have said that on here, and it keeps me pushing the envelope. Keep going!

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Weirdly I find going to the gym makes me feel better. I used to do a lot of weights but after a long break due to the pandemic then getting MAV I cant seem to get back into them. I’ve always found weights tedious if I’m being honest, never got the buzz that I get from aerobic exercise.

I can happily spend an hour going on cross trainers, bikes, rowers or treadmills and I dont notice my dizziness too much. Afterwards I feel less imbalanced. I’m sure there are psychological factors at play, being distracted, not focusing on myself, as well as increased blood flow and the ole endorphins helping.


I think thats great advice. I’ve certainly felt I could have easily descended into avoidance behaviour, especially last year, early on when my symptoms were at their most severe. It was much more comfortable just to sit on the couch and not move.

But I forced myself to do the things I found hard and still do, to some extent. Walking around, going outside, going to the shops. I didnt want to let this hateful condition take away the everyday things that others take for granted but which are so hard for us MAVers.


hmmm maybe im doing something wrong then. thanks for the reply

In my transition from really bad (dizzy 24/7 for months) to not so bad (not dizzy for at least some part of the day), I started running a mile everyday and then eventually 2 miles and that was the only time during the whole day I felt “normal”. I’m convinced this got me out of the hole at least mentally, I also noted a marked difference in my dizziness (granted I was changing a lot of variables at this time like meds and diet). I did have a couple times later on where running on a dizzy day made me feel a little worse so now I lift weights or some athletic activity everyday. That being said I want to get back into running because it’s so motivating and reminds me that my body is still capable. Would recommend.


I have found that doing gentle aerobic exercise has triggered migraines. I think that the head jolting from jogging/jumping is a trigger for me. I’ve been doing gentle strength exercise instead and have found that okay. Also walking is generally okay (though I had a migraine in the middle of a 5 mile walk on dart moor -possibly too ambitious!) I’m hoping to try going back to Pilates and to try an exercise bike for cardio.

Thanks for telling us how you are doing. It’s wonderful you have improved so much. Long may it continue!


I definitely find exercise is extremely important in dealing with mood , anxiety, and VM. I’m curious why you think strength training is probably better than moderate CV exercise. I plan to start doing some strength training anyway. It will be a challenge because it’s being a long time and I’m 62 and very overweight but baby steps I guess. It’s funny I’m even looking at this now as I am hopefully at the tail end of an episode and screens aren’t the best thing . I’m a newbie here though and I’m sure lots of people have commented on the irony of going to a computer screen for help.

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Hi there, what you said about the jumping makes a certain amount of sense. I’m a former massage therapist and I can envision all the muscles, including the very small ones, at the base of the skull being stressed. Of course that’s just my perspective and it could be something else entirely. Perhaps just the movement messing with the inner ear

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i really dont have any basis for suggesting that – I would think that muscle hypertrophy causes an increased need for mitochondrial biogenesis in new muscle which would also impact preexisting mitochondria, but pure conjecture.

I think the key is any exercise, although I’m sure for most people it makes sense to start with aerobics/low impact cardio and working your way up.

By the way, welcome to the forum! There are users here of all ages and nationalities so chances are someone will always have the knowledge to at least point you in the right direction when it comes to questions.

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Thank you. When you’re talking about mitochondria you’re getting a bit out of my league. I’m sure I learned something about them back in massage school a long long time ago.

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Thank you for testimonial!
It gives me a lot of HOPE! I desperately needed that.

Just always remember to stay safe. My vertigo is so bad, I’ve been using a walker for 5 months.


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Be hopeful! All problems can be solved…except for time travel and a short list of other things that physics would tell you isn’t possible.

Thankfully the list is very short

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