Why have symptoms worsened after progress with VRT?

Hi I’m new here. I was diagnosed with MAV last November. My neurootologist put me on a migraine diet and VRT. For three months I only mangaged 3 rotations 3 times a day as opposed to the prescribed 10. I lay down for most of the day then after 3 weeks I was able to drive a short way and go into a supermarket.

I tried to get uptp 4 rotations abut just felt too ill as if I were being pulled to the ground. I saw my specialist again . He told me to take one set of exercises to 5 rotations until I saw a VRT therapist. I did and although it took it’s toll by worsening my symptoms by 3 weeks my symptoms improved and I was able to go out and even eat out.

Meeting the VRT therapist, she decided i break the exercises dwon by stil doing the 3 rotaions but do them 5 times daily. I did this , improved and felt none of the horrendous efects of trying to do 10 3 times a day. At our next meeting in Mya this year she said that benefits can only be felt by dong the VRT 10 x 3 a day. SO I made the break by gradually getting them upto 10rotations 3 times daily.

Still felt about 60% better,i was puzzled that I didn’t have the kick bcak that I did before which is evidence that the VRT is working. %6 weeks of this and some bad days but more good culminating in 3 very busy days alsy week one of which I went to a party. Howvere the next day and a full blwon MAV attack which has got worse all week.

My questions are; Why has the MAv got worse despite the VRT? Did the couple of very weak teas make a difference? OR is my brain now responding to the VRT and will calm dwon when it has ajusted?

nb I have tried amritptiline, nortriptyline and pizofen all of which made my smptoms much worse.

sorry this is so long!

Hi Fiona,

Welcome to mvertigo … and really glad you found the forum. Your problem with VRT is not unusual at all. In fact, it’s diagnostic for MAV! If you check out the MAV FAQ above you’ll see a really comprehensive article and summary by Professor Rauch. Note he says the following:

— Begin quote from ____

Migraineurs who develop an inner ear balance condition tend to be sicker than non-migraineurs with the same illness. They are often slower to recover and at greater risk of incomplete vestibular compensation. In my experience, migraineurs are the only patients whose symptoms get WORSE when they attempt vestibular rehabilitation physical therapy. This is practically diagnostic of migraine. In fact, in management of inner ear balance disorders (VN, labyrinthitis, relapsing BPPV, Meniere’s disease, etc), a diagnosis of migraine trumps all of these other conditions – unless and until the migraine is controlled/suppressed, the treatments for the inner ear disease tend to be ineffective.

— End quote

In short, if VRT is making you worse, you should either stop or SLOW it down. It may simply be a matter of following a strict diet to remove the offending triggers (caffeine for example) and, if that’s not sufficient, another migraine suppressant would be your next move. This alone might completely clean up the dizziness without VRT (particularly if there is no vestibular damage). Could you try an SSRI such as Zoloft next?

Scott 8)

Hi Fiona

I think your MAV probably got worse because you had an overload of triggers that particular week - tea, busyness, party etc. Til things get more stabilised we MAV’ers haveto be aware of not overdoing it sometimes and even after stabilisation we still have to be trigger aware. It’s a steep learning curve, particularly at the beginning when a small relapse in diet or getting more stressed or tired than usual can be the thing that tips us over the edge into worsening dizziness.

As for your question about the weak tea, for me personally I would have to say yes but we’re all different so we all have to find out for ourselves what affects us.

Shame the meds didn’t work for you. Me neither. VTR made me worse so I had to abandon it.

Don’t get too disheartened - it’s sometimes like four steps forward and two steps back to start with and it’s difficult to sort out all the signals and symptoms as to exactly what is going on and why. Hope things have calmed down for you now.


Thanks for your help and advice.

Hi Fiona,
Glad to hear you got better, sorry you had a setback! I was wondering how many exercises you do? My therapist gave me 7 different exercises and told me to do them each of them 2 times a day, Is that what you mean by rotation? I was told if you do them too much you can get overload, but now I wonder if maybe I should try and do them a little more. I do have a slight problem with my left ear so I know I need to do them.