What is migraine associated dizziness?

Migraine associated dizziness (MAD) is a common cause of recurrent vertigo that affects approximately one third of those who complain of migraines. It has also been referred to as vestibular migraine, migraine associated recurrent vertigo, benign recurrent vertigo, migraine related vestibulopathy, and migrainous vertigo. There are no uniformly agreed upon definitions or terminology for migrainous vertigo.

​

​

How is migraine associated dizziness/vertigo diagnosed?

Diagnosis is often determined by a subjective history after ruling out other pathological mechanisms. Proposed criteria by Neuhauser and Lemper for diagnosis of migrainous vertigo are as follows:

•  Episodic vestibular symptoms of at least moderate severity (rotational vertigo, other illusory self or object motion, positional vertigo, head motion intolerance, sensation of imbalance or illusory self or object motion that is provoked by head motion)

•  Migraine according to the IHS criteria: Migraine without aura, migraine with aura, migraine with prolonged aura, basilar migraine, migraine aura without headache, childhood periodic symptoms, benign paroxysmal vertigo of childhood, migrainous infarction

•  At least one of the following migrainous symptoms during at least 2 vertiginous attacks: migrainous headache, photophobia, phonophobia, visual or other auras

•  Other causes ruled out by appropriate investigations

​

​

What are the common symptoms of migraine associated dizziness ?

•   Vertigo and headache, which may not occur simultaneously

•  Symptoms can occur prior to the onset of headache, during a headache, or, as is most common, during a headache-free interval

•   Dizziness may occur during menstrual cycle in women

•   Migrainous vertigo can last several minutes or several hours without dizziness between attacks

•  May manifest as episodic rotational vertigo with or without nausea and vomiting, positional vertigo, constant imbalance, movement-associated disequilibrium, illusory self or object motion, head motion intolerance, and/or lightheadedness

•  Photophobia, phonophobia

​

​

How can physical therapy help me with migraine associated dizziness (MAD) ?

Vestibular rehabilitation including habituation exercises to decrease sensitivity to activities that provoke dizziness, gait training, and balance training can help with the management of MAD. Reducing or eliminating triggers (including dietary and environmental), managing stress, and using prophylactic and/or abortive medication for migraine can also help manage MAD.

​

​

What are my therapy sessions going to be like?

Therapy for vestibular disorders takes many forms. A qualified physical therapist will first perform a thorough evaluation that begins with a medical history and includes observing and measuring posture, balance and gait, and compensatory strategies. The assessment may also include eye-head coordination tests that measure how well a person’s eyes track a moving object with or without head movement. Using the results, the therapist will develop an individualized treatment plan that includes specific head, body, and eye exercises to be performed both in the therapy setting and at home. The type of exercise utilized depends upon the unique problems that the individual demonstrates during the evaluation. Some exercises are geared toward helping with balance, some with helping the brain resolve differences in the inner ear signals, and some with improving the ability to visually focus. In addition, general exercise is often prescribed to improve overall physical health and well-being. 

​

How soon can I expect to see improvements?

Each patient is unique, so this time frame can vary greatly. Research shows that depending on the severity of your condition, it takes from 2 weeks to a few months of treatment to resolve a vestibular condition. We most often request a frequency of 2-3 times a week for 12 total visits. That is why our office staff will ask you to schedule all 12 of your sessions before starting therapy. If you need more than 12 sessions, your therapist will discuss this with you after you have completed 12 visits and you will decide together whether continuing with therapy would benefit you or not. If so, your therapist will reevaluate you and send a progress note to your physician requesting an extension.

​

What are the credentials of my physical therapist?

All licensed physical therapists have had to apply and be selected to attend Physical Therapy school. It is a very competitive process and only those will the highest grades and best potential are selected. Doctors of physical therapy have invested a minimum of 7 years into their undergraduate and graduate training at universities. Once they graduate, they have to sit for a State Board Exam and pass to receive their license to practice. In order to keep their license active, they must dedicate a certain number of hours to continuing education each year.

At Anchor Physical Therapy we also require that therapists attend multiple post-graduate continuing education courses every year to stay up to date with latest research and continuously enhance their treatment skills in order to achieve the best possible treatment outcomes for our patients.