Vestibular Migraine
Vestibular Migraine
Vestibular migraine is a type of migraine in which patients will experience symptoms such as dizziness, loss of balance/unsteadiness, pulsating unilateral headache, visual aura and sensitivity to lights and/or sounds. Patients may also experience feelings of anxiousness or lose confidence in themselves (Olesen et al., 2018).
Vestibular migraine presents with headache, head pain or heaviness in around 50% of patients. The other 50% of patients do not experience headache, meaning vestibular migraine is often misdiagnosed as vertigo or blood pressure issues. When misdiagnosed you can almost guarantee it is mis treated and patients never find the success they need.
It is considered the most common form of spontaneous episodic dizziness and the second most common form of dizziness (Bisdorff, 2011).
The duration of vestibular migraine attacks are highly variable, typically lasting from 5 minutes to 72 hours however some episodes may only last seconds and others can last a month or even up to years (Olesen et al., 2018).
Benign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is a common cause of dizziness which occurs when calcium crystals (known as ‘otoconia’) become stuck in the canals of the inner ear, most commonly the posterior canal. BPPV can affect all ages but most commonly affects 50 - 70 year olds. Onset of BPPV is often insidious however it can also arise from infections or traumas such as a concussion or whiplash type injuries.
Symptoms of BPPV include:
- Dizziness or vertigo
- Lightheadedness
- Imbalance
- Nausea and/or vomiting
BPPV symptoms are almost always precipitated by a change of position of the head in relation to gravity such as getting out of bed or a chair, or rolling over in bed. Patients may also experience BPPV when looking up (Hain, 2021).
At MHNJ we are trained to effectively assess, diagnose and treat BPPV. We use a range of treatment techniques like the Epley Manoeuvre and Osteopathic treatment to the upper neck to manage BPPV and empower our clients to self manage their dizziness at home without the need for medication. Patients who have confirmed BPPV should expect complete resolution from one to two sessions.
Cervicogenic Dizziness
Cervicogenic Dizziness
Cervicogenic dizziness is a condition characterised by dizziness and associated neck stiffness or dizziness associated with neck pain. Cervicogenic dizziness is thought to arise from a mismatch between the nerves in our neck and the input from the nerves of the eyes and inner ear (our balance system). These two groups of nerves interact in our brainstem and overtime, can cause a condition named brainstem sensitisation, which results in dizziness (Knapstad, Nordahl and Goplen, 2019) (Suska, 2016).
Symptoms of cervicogenic dizziness include neck pain and/or loss of range of motion accompanied with:
- Dizziness
- Sensations of motion
- Disorientation
- Unsteadiness and/or lack of balance/stability
- Lightheadedness
Cervicogenic dizziness is often difficult to diagnose and is diagnosed after other forms of dizziness (BPPV, Meniere’s etc) are ruled out.
Treatment of the neck often improves symptoms in patients suffering from cervicogenic dizziness however for about 25% of patients, vestibular rehabilitation is also necessary (Knapstad, Nordahl and Goplen, 2019) (Suska, 2016).
At MHNJ we draw on effective examination techniques to correctly diagnose your condition, then utilise a combination of Osteopathic techniques, the Watson Headache approach and vestibular rehabilitation to treat your cervicogenic dizziness and decrease the sensitivity of your brainstem.
Persistent Perceptual Postural Dizziness (PPPD)
Persistent Perceptual Postural Dizziness
PPPD is a relatively new diagnosis and is one of the most common forms of chronic dizziness in the middle aged population.
Symptoms of PPPD include:
- Non-rotational vertigo, dizziness and/or unsteadiness for more than three months
- Hypersensitivity to motion - e.g. your own head or body movements or movements of objects in your vision
- Visual difficulties (Holle et al., 2015)
PPPD often starts after an acute vestibular disorder or episode such as
- Vestibular migraine
- Benign paroxysmal positional vertigo (BPPV)
- Meniere’s disease
- Concussion
- Neck pain and/or whiplash
- Panic attacks and/or anxiety attacks (Holle et al., 2015)
PPPD is often diagnosed by excluding other causes of dizziness first. At MHNJ we take the time to understand your condition and symptoms to correctly diagnose PPPD. Once a PPPD diagnosis is established we treat PPPD with a combination of vestibular rehabilitation techniques, patient education and manual therapy. Chronic dizziness is often worrying for patients therefore we feel it is important for you to understand your condition.
References
Hain, T., 2021. BPPV -- Benign Paroxysmal Positional Vertigo. [online] Dizziness-and-balance.com. Available at: <https://dizziness-and-balance.com/disorders/bppv/bppv.html> [Accessed 4 June 2021].
Holle, D., Schulte-Steinberg, B., Wurthmann, S., Naegel, S., Ayzenberg, I., Diener, H., Katsarava, Z. and Obermann, M., 2015. Persistent Postural-Perceptual Dizziness: A Matter of Higher, Central Dysfunction?. PLOS ONE, 10(11), p.e0142468.
Knapstad, M., Nordahl, S. and Goplen, F., 2019. Clinical characteristics in patients with cervicogenic dizziness: A systematic review. Health Science Reports, 2(9), p.e134.
Suska, J., 2016. Manual Therapy for Cervicogenic Dizziness: Long-Term Outcomes of a Randomised Trial. physioscience, 12(02), pp.80-81.
