All Posts tagged Migraine

Vestibular Rehabilitation

Vestibular Rehabilitation

By Vanessa Service, Physiotherapist

What does my vestibular system do?

Your vestibular system’s job is to process sensory information that is required to control balance and eye movements. This means that information from the inner ear, the visual system, and from the muscles and joints is analysed by the brain. Integrating this information allows you to1:

– Maintain clear sight while you move your head,

– Figure out the orientation of your head in space in relation to gravity,

– Identify how fast and in which direction your are moving, and

– Make fast and automatic adjustments to your posture so you can maintain balance (stay in your desired position).

In other words, your vestibular system coordinates your movement with your balance, allowing you to navigate through and adapt to the world. It is this process that allows you to walk down the sidewalk, to step off a curb, to sit down and stand up again and to turn your head while walking. Anytime your head moves through space you’re depending on your vestibular system.

What are vestibular disorders and what are the symptoms?

If the vestibular system encounters disease or injury, such as a viral infection or head trauma, the result may be a vestibular disorder. However, aging, some medications, and genetic or environmental factors may also cause vestibular conditions.

Symptoms of damage to the vestibular system may include:

– Vertigo (a sense of the world spinning around you)

– Dizziness (feeling lightheaded or floating/rocking in space)

– Imbalance and special disorientation (stumbling, staggering, drifting to one side while walking)

– Difficulty with changes in walking surfaces

– Tinnitus (ringing or buzzing in the ears)

– Discomfort in busy visual environments (such as the grocery store) or when looking at screens/television

Examples of vestibular disorders include:

  • Benign paroxysmal positional vertigo or BPPV (a common condition where loose debris or “crystals” collect in a part of the inner ear)
  • Vestibular neuritis or labyrinthitis.
  • Migraine associated vertigo
  • Concussion
  • Endolymphatic hydrops
  • Acoustic neuroma
  • Meniere’s disease

How can a vestibular physiotherapist help?

The effect of a vestibular condition on a person’s life can be profound. Dizziness and balance problems are often a barrier to activities of daily living, to independence, and to engaging with the community. This negative impact on daily function and socialization may also contribute to anxiety and depression. As such, appropriate management of vestibular conditions is an essential component to improving quality of life for individuals and families affected by vestibular disorders.

A vestibular therapist will interview you about the history of your symptoms and perform a series of vestibular, balance, and visual tests. Treatment will depend on what is found in the assessment. For example, if you are diagnosed with BPPV, your therapist will perform a manoeuvre to reposition the associated crystals. Other vestibular disorders are treated with specific exercises and strategies that your vestibular therapist will teach you and help you progress through to reach your specific goals.

Although for most people a vestibular disorder is permanent, an exercise based plan can be designed to reduce dizziness, vertigo, and balance and gaze stability problems1. This is made possible by your brain’s incredible ability to adapt its other systems in order to effectively compensate for an improperly functioning vestibular system. Vestibular rehabilitation is a non-invasive and drug free intervention that helps to promote and maximize the amount of compensation that occurs. Current research supports the use of vestibular rehabilitation in the management of vestibular conditions2, demonstrating reduced dizziness, balance issues, and increased independence with regard to activities of daily living 3. Additionally, no adverse effects associated with vestibular rehabilitation have been reported2. As such, vestibular rehabilitation can provide a pathway to improved quality of life for those living with a vestibular condition.


1. About Vestibular Disorders (n.d) Retrieved from

2. Hillier SL et al., Vestibular rehabilitation for unilateral peripheral vestibular dysfunction, Cochrane Database of Systematic Reviews 3, 2011.

3. Cohen HS, Kimball KT Increased independence and decreased vertigo after vestibular rehabilitation. Otolaryngol Head Neck Surg 2003 Jan;128(1):60-70


Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV)

Feeling dizzy? You Could Have a Vestibular Disorder

Do you experience dizziness? Perhaps when rolling into or over in bed, or turning your head to one side?

Dizziness can be more than dehydration, a big night out, or a compulsion to spin in circles on your office chair. It can be a symptom of asymmetry in your body’s sensory systems.

The most common condition that causes dizziness is benign paroxysmal positional vertigo, or BPPV. The brain has three main mechanisms for perceiving how we interact with the environment around us. These are the visual, proprioceptive, and vestibular systems.

The visual system is self-explanatory. The proprioceptive system is a network of nerves in all of your muscles and joints that relay information about the position of those muscles and joints back to the brain. It is how you can close your eyes and still accurately position your arms and legs in different poses.

The vestibular system is located in your inner ear and is used to identify the position and movement of the head in space. This is the system commonly linked to dizziness and vertigo.

The vestibular system is made up of three perpendicular fluid filled canals in each ear, which relate roughly to the planes of movement.

These canals each have sensory nerves at one end that are made up of crystals resting on fine hairs. When you turn your head, the fluid moves through the canals and pushes on the crystals. This causes the hairs to move and stimulates the nerves.

Your response in each ear should be equal and opposite, and work in tandem with your visual and proprioceptive systems. If things are not working in tandem, then dizziness, vertigo (room spinning), or nausea may result.

Have you ever felt nauseated in a car, or on a boat? This is because your vestibular system recognises that your head is moving but according to your eyes, you are still or moving a different way.

Someone may have suggested looking out the window or finding the horizon. This is great advice as fixating on something which the car or boat is moving relative to, provides a visual reference point and reduces or eliminates the disagreement between the visual and vestibular system.

In patients suffering BPPV, a similar disagreement occurs but it is completely internal. It occurs when crystals in one ear canal become dislodged from the hairs and drift down into the canal. This can happen as a result of trauma but is just as frequently unrelated to any incident.

When the head is turned, the nerve stimulation in one ear is different to the other and a combination of dizziness, vertigo, and nausea can result.

Generally, this resolves in seconds, or in more severe cases last up to two minutes. Usually only one canal will be affected at a time so symptoms are commonly worse to one side, and occur most severely in a single plane of movement.

If you are dizzy due to asymmetry, then your physiotherapist can assess and treat it. Assessment of specific movements can isolate which ear and which canal is causing the problem and treatment involves techniques designed to use gravity and inertia to relocate the crystals back to where they belong at the end of the canal.
NOTE: If you are suffering from severe, sudden onset headache, or persistent dizziness, double vision or nausea that seem unrelated to any particular movement then consult a medical doctor immediately.


Are Headaches a Pain in the Neck?

Are Headaches a Pain in the Neck?

Headaches are a problem that affects at least 90% of us during our lifetime. There are multiple types of headaches that vary in symptoms and severity, with some of the more common types including tension-type, migraine and cervicogenic headaches. A number of headache types share common contributing factors to their source of pain, including that they often originate or are linked to the neck region. Some of the following signs may indicate that your headache may be neck related:

Pain and tension through the neck
Pain is initiated or increased with neck movement or prolonged neck posture
Neck range of motion is reduced
The pain may be more prominent or localised to one side, or may exist on both sides of the head
Pain may be experienced from the base of the skull and often refer around the skull or behind the eyes
There may be a feeling of dizziness or light headedness
History of acute trauma or repetitive trauma to the neck region
Diagnosis of headache type is critical for effective management and is an area where physiotherapists can utilise their assessment skills to help differentiate which type of headache is present. Physiotherapy invention can be very effective in managing headaches with a cervical spine (neck) related origin. A physiotherapist will assess the joints of your neck, associated muscles and neural structures to identify any abnormalities. Your posture and work ergonomics may also have a significant impact on headache development and persistence, which are areas that physiotherapists have expertise.

Physiotherapy management may include any of the following depending of your specific presentation and symptoms:

Joint mobilisation

Soft tissue mobilisation/massage
Stretching of tight structures
Postural advice and correction
Strengthening of important neck stabilising muscles
Ergonomic assessment/advice for your work place set-up
Stress and tension management
If any of the above physical symptoms are sounding familiar you may find that your pain in the neck was the cause of your headache all along.


Migraine Headaches: Feel better today

Migraine Headaches: Feel better today
If you’ve ever had a migraine you know how miserable the relentless pain, nausea and sensitivity to light can make you feel— now imagine what it’s like for a child.
For children, migraines can be so severe that they affect learning, athletic performance and friendships.
Here, find out if your kid is susceptible to migraines, learn the symptoms (Hint, it’s not a throbbing headache), and the easy fixes that will help him feel better in no time.
Migraines are common in children
About 10 percent of children between the ages of 5 and 15 suffer from migraines. Before puberty, it’s seen in about the same number of boys and girls but after it’s higher in girls because of the rise in estrogen. In fact, about 50 percent of girls will experience migraines a few days before or on the first day of their menstrual periods.
Migraines have been reported in babies as young as 18-months-old. Although it’s more difficult to identify, if there’s a family history or a parent is a migraine sufferer, they may be able to recognize the signs early.
There’s also some evidence that if a baby has colic, they’re more likely to have migraines as they get older.
“The abdominal symptoms of colic are actually early manifestations of migraine,” said Dr. Andrew D. Hershey, endowed chair and director of neurology and of the headache center at Cincinnati Children’s Hospital Medical Center.
Plus, two conditions, benign paroxysmal torticollis— which can cause a stiff neck— and benign positional vertigo— which can cause a child to suddenly fall— are also thought to be precursors to migraines, said Dr. Howard Jacobs, a pediatrician, headache specialist and an associate professor of pediatrics at Children’s Hospital in Columbus, Ohio. Kids who tend to get carsick may be more likely to have migraines, as well.
Although there is a strong genetic link to migraines, environmental factors such as skipping meals or changes in sleep patterns that stress the hypersensitive nervous system into having a migraine can play a role too, Hershey said.
Symptoms of migraines
Unlike tension headaches that can progress from mild to moderate, migraines advance from moderate to severe. What’s more, migraines in kids often look very different than when adults get them.  For starters, kids usually don’t have a pounding headache but more of a steady pain and it’s usually on both sides of the head.
Children with migraines tend to complain of sensitivity to light and sound, dizziness, nausea, vomiting, and sweating. Approximately 10 to 25 percent will also experience an aura, such as blurry vision, flashing lights and colored spots before the headache.
Plus, some school-age children have symptoms of a migraine without ever having a headache. It’s a syndrome known as cyclic vomiting and it’s marked by episodes of vomiting over a few hours that often require hospitalization, as well as dizziness and sensitivity to light.
Other children may go undiagnosed because they have an “abdominal migraine,” that causes abdominal pain, usually without fever, diarrhea or vomiting without ever experiencing a headache.
Bright classroom lights, lots of noise, homework, peer pressure and bullying is enough for any kid to deal with, but for kids with migraines, it translates to missed school days, problems with learning, extra-curricular activities, sports and socializing. What’s more, between 30 and 40 percent of children with migraines also have anxiety. Kids can be criticized and their peers may even think they’re faking it, since it’s not as obvious a problem as getting the flu might be.
6 ways to prevent and treat migraines
Ask the doctor.
“When a kid says they have a migraine, it’s not just a bad headache and it should be taken seriously,” Jacobs said.
The first step is for your child to see his primary care physician to make sure his symptoms are those of a migraine. For most children, over-the-counter ibuprofen or naproxen may be enough. However, your child shouldn’t take them more than three times a week, because kids with migraines tend to be more sensitive to pain medication. So if they’re taken too often they can get a medication overuse headache which will have the reverse effect, Jacobs said.
Your child’s doctor may also prescribe a prescription medication or natural supplements like feverfew or butterbur, but it’s important to understand the side effects before opting for them.
Eat healthy.
Eating a healthy diet that consists of fruits and vegetables, lean protein, healthy fats and whole grains and eating three meals a day can help stave off hunger and prevent a migraine. Plus, your child should drink enough water so that his urine is clear.
“Their heart is trying to pump energy up to their brain, and the better hydrated they are, the easier it is for the heart to do that,” Jacobs said.
Studies show that obesity is linked to migraines, and one of the best ways to make sure your child has a healthy weight along with diet is to exercise. What’s more, regular exercise will increase energy in the cells of the body and reduce stress that leads to migraines. Your child should break a sweat 30 to 45 minutes, three to four days a week.
Check nutritional deficiencies.
Certain supplements like riboflavin or coenzyme Q10 (CoQ10) can help if your child is deficient. Magnesium may also prevent a migraine, but you should talk to your child’s doctor first.
Getting enough sleep is also an important way for children to ward off a migraine. The National Sleep Foundation recommends school-age children get 9 to 11 hours of sleep each night, while teenagers (14- to 17-year-olds) should get 8 to 10 hours.
Deal with stress.
Modeling and teaching your child coping skills and ways to manage stress is key, especially during the back-to-school season when headaches spike for children, a study from Nationwide Children’s Hospital found. Seeking out Cognitive Behavioral Therapy (CBT) with a trained therapist may also help.
Julie Revelant is a health journalist and a consultant who provides content marketing and copywriting services for the healthcare industry. She’s also a mom of two. Learn more about Julie at