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Old 07-10-2007, 06:59 PM   #1
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Question vestibular migraine - any use for VRT?

Hi All,

In recent discussions it has been suggested that VRT may be hopeless for someone with migraine associated vertigo (MAV). Even Dr Rauch made a comment that when VRT fails it usually points to migraine interfering with the process of recovery. And this makes sense. How can VRT work you would think when there is some neurological process undermining everything all the time?

But here's a study that refutes the above:

Quote:
Physical Therapy for Migraine-Related Vestibulopathy and Vestibular Dysfunction With History of Migraine
SL Whitney et al.
Laryngoscope. 2000 Sep;110(9):1528-34.

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.
Best ... Scott

 
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Old 07-11-2007, 05:17 AM   #2
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Re: vestibular migraine - any use for VRT?

Scott:

Just to emphasize your point my doctor said the same thing. He said most of his cases go through the same proccess where they know they have a vestibular problem and all try the VRT route. That is par for the course and how treatment should be approached. The tests show vestibular function is abnormal so you need to try the inner ear 1st as that is the base of the vestibular system.Then when no signifigant progress or not eneough progress with VRT the patients will be referred to him for Migraine treatment. The problem he say is the patient like myself who was doing VRT and then taking an SSRI at the time for anxiety. The SSRI in realty is treating my MAV indirectly and I start feeling better. however I assume the VRT is helping me but in realty it is the Migraine Medication Zoloft. I continue with VRT and I am in a standstill until I treat the MAV with Verapamil . However that was over a year later. But if you indeed have VN you need the SSRI to control the anxiety as the anxiety can slow down your VRT recovery. It is a catch 22 which is why for myself and others it takes so long to put the puzzle together

Howie

 
Old 07-11-2007, 07:50 AM   #3
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Re: vestibular migraine - any use for VRT?

Hi Howie,

A puzzle it certainly is! Actually it's more like trying to dicipher ancient Egyptian hieroglyphics - impossible at times.

Wanted to ask you how you felt on your first doses of Verapamil. I had only one hit on Sunday, felt really out of it in a different sort of way and then decided to stabilise for a while on this higher dose of Cipramil without Verapamil for now. Just like you the SSRI has been treating the MAV as the main target all of this time and mopping up anxiety too. I always thought it was only the anxiety keeping me held back (which is partially true) but it was the MAV.

So how did you choose to end up on 160 mg?

Cheers....Scott

 
Old 07-11-2007, 08:50 AM   #4
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Re: vestibular migraine - any use for VRT?

Scott:

I started at 120 Mg's and then to 180 Mg's...Not sure why the doctor chose that dose but he said he could move up even more if needed. I had some side effects such as urinary retention which the medication might be the cause. They suspect the medication but it could be my body and the medication just emphasized this more. All Urological tests were normal and the side effects are minimal. Much beeter than the dizziness. As far as your feeling off or out of it..I never had that but I have high blood pressure already and I just switched by medication from norvace to Verapamil to treat both at once

Howie

 
Old 07-11-2007, 04:32 PM   #5
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Re: vestibular migraine - any use for VRT?

This is the clincher

"There appears to be an improved outcome if a patient is taking an antimigraine medication in conjunction with physical therapy intervention"

It doesn't really refute what we often say, which is you need to stabilise the condition with anti-migraine treatment before doing VRT. There's no doubt it can help get rid of the residual problems.

 
Old 07-12-2007, 12:58 AM   #6
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Re: vestibular migraine - any use for VRT?

Adam,

Quote:
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.
Scott

 
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