Vestibular Rehab Blog Series: 7 of 12
Okay, so migraine associated vertigo, we know this is very similar to Meniere’s attacks in the acute phases. You're going to have medicines to alleviate the severity of the vertigo (meclizine, valium) and medications for nausea. Now, the long-term treatment, I think the most conservative is lifestyle changes. Again, supplements oftentimes B2 (riboflavin) and magnesium [are given]. If that's not enough, migraine medicine [is prescribed]. Diet to avoid migraines triggers as well as the impact of alcohol, caffeine, sugar, and smoking. Again, we do see a higher recurrence of the vestibular migraines with allergies and especially changes in the barometric pressure. Vestibular rehab can be beneficial if the patient is stable. If they are having migraine after migraine after migraine, the priority is to always stabilize the patient by getting their migraines under control, getting the fluctuations and the fluid problem under control, and then see if the vestibular rehab is needed.
As an FYI, sometimes medications to stabilize the inner ear are sometimes used in combination with migraine meds. And that's because there is a population that has both Meniere’s disease and migraine component. We talked about an inner ear infection. Now in the early phases, once again, medicines to decrease the vertigo and nausea. So, there's a neuritis and then with labyrinthitis, and if you remember, that's with hearing loss, you oftentimes see an added pharmaceutical intervention through the use of steroids and possibly antivirals. Now, long term or post-acute, we want to see them come off of the suppressants, particularly meclizine, the number one treatment for vertigo. It can have a minimal benefit and it hinders the natural recovery compensatory process. Now as a physical therapist. I cannot advise anyone to start or stop medications. However, providing them with patient education is important. We provide them handouts on all of these different disorders and in those handouts it does discuss how meclizine can actually hinder the recovery process. It also increases the risk for falls. And then initiation of a vestibular rehab if the patient has residual symptoms. And what I mean by this, we will see patients that are sent over, most commonly, a primary care physicians office who has a patient in their clinic with vertigo, and they're asking us to see them ASAP. That patient may have an inner ear infection. We're not even going to put them through the vestibular diagnostics in the acute phase, but evaluate them to see if we get clues from the history and the exam that indicate an inner ear infection and refer them back to the doctor for medical management as needed. Oftentimes after that acute phase is over, they make a complete recovery and don't need vestibular rehab. And you may experience this, too, where someone may be on your schedule and then they call and cancel because all their vertigo is gone. They may have had an inner ear infection that has completely self-resolved. They may not know that they have migraine associated vertigo or possibly Meniere’s. They're having these spells that spontaneously recover. You kind of figure that something more is going on if that same patient calls and says it's back.
Click here to progress to the next blog in this series: Clinical Tests to Treatment: Superior Canal Dehiscence (SCD) and Perilymphatic Fistula