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Journal of Neurology

, Volume 260, Issue 12, pp 3039–3048 | Cite as

Vestibular rehabilitation outcomes in patients with and without vestibular migraine

  • Jessica VitkovicEmail author
  • Arimbi Winoto
  • Gary Rance
  • Richard Dowell
  • Mark Paine
Original Communication

Abstract

Vestibular rehabilitation programs do appear to play a beneficial role in the treatment of dizziness in patients with vestibular migraine. Anecdotally, however, patients with vestibular migraine may report persistent significant symptoms at the end of a standard treatment period where other non-migrainous patients are accomplishing their treatment goals. Therefore, the objective of this study was to assess the efficacy of vestibular rehabilitation in patients with vestibular migraine compared to patients with vestibular symptoms without migraine. Thirty-six patients (vestibular migraine = 20, vestibular impairment = 16) with significant daily vestibular symptoms received a nine week customized vestibular rehabilitation program. Each subject attended five therapy appointments occurring at initial, two, five, nine and six months. A range of subjective and physical performance outcome measures were taken at baseline, nine weeks and six months. The vestibular migraine group showed poorer subjective performance at the onset of therapy, which was not reflected in the difference in physical performance between the groups. Both groups benefitted equally from rehabilitation. The same degree of improvement was observed in the migraine group regardless of medication regime. This study has validated vestibular rehabilitation as an effective treatment in dizzy patients both with and without vestibular migraine where the use of medication did not preclude benefit from therapy. However, further research is required to clarify the role of specific vestibular suppressant medications and the scheduling of their use in relation to physical therapy.

Keywords

Vestibular migraine Vestibular rehabilitation Neuro-otology Sensory sensitivity 

Notes

Acknowledgments

This study was supported by the Royal Victorian Eye and Ear Hospital (06/704H). The authors would like to thank the staff at the Vestibular Investigation Unit for their contribution to the collection of patient data, and the manuscript reviewers for their comments.

Conflicts of interest

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplementary material

415_2013_7116_MOESM1_ESM.pdf (52 kb)
Supplementary material 1 (PDF 52 kb)
415_2013_7116_MOESM2_ESM.pdf (62 kb)
Supplementary material 2 (PDF 62 kb)
415_2013_7116_MOESM3_ESM.pdf (71 kb)
Supplementary material 3 (PDF 71 kb)

References

  1. 1.
    Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Newman-Toker D (2012) Vestibular migraine: diagnostic criteria. J Vestib Res-Equilib Orientat 22(4):167–172. doi: 10.3233/ves-2012-0453 Google Scholar
  2. 2.
    Radtke A, von Brevern M, Neuhauser H, Hottenrott T, Lempert T (2012) Vestibular migraine Long-term follow-up of clinical symptoms and vestibulo-cochlear findings. Neurology 79(15):1607–1614CrossRefPubMedGoogle Scholar
  3. 3.
    Fotuhi M, Glaun B, Quan SY, Sofare T (2009) Vestibular migraine: a critical review of treatment trials. J Neurol 256(5):711–716CrossRefPubMedGoogle Scholar
  4. 4.
    Best C, Eckhardt-Henn A, Tschan R, Dieterich M (2009) Why do subjective vertigo and dizziness persist over one year after a vestibular vertigo syndrome? In: Basic and clinical aspects of vertigo and dizziness. Annals of the New York Academy of Sciences, vol 1164, Blackwell publishing, Oxford, pp 334–337Google Scholar
  5. 5.
    Enticott JC, Vitkovic JJ, Reid B, O’Neill P, Paine M (2008) Vestibular rehabilitation in individuals with inner-ear dysfunction: a pilot study. Audiol Neuro-Otol 13(1):19–28. doi: 10.1159/000107434 CrossRefGoogle Scholar
  6. 6.
    Whitney SL, Rossi MM (2000) Efficacy of vestibular rehabilitation. Otolaryngol Clin North Am 33(3):659–672CrossRefPubMedGoogle Scholar
  7. 7.
    Wrisley DM, Whitney SL, Furman JM (2002) Vestibular rehabilitation outcomes in patients with a history of migraine. Otol Neurotol 23(4):483–487CrossRefPubMedGoogle Scholar
  8. 8.
    Whitney SL, Wrisley DM, Brown KE, Furman JM (2000) Physical therapy for migraine-related vestibulopathy and vestibular dysfunction with history of migraine. Laryngoscope 110(9):1528–1534CrossRefPubMedGoogle Scholar
  9. 9.
    Neuhauser H, Leopold M, von Brevern M, Arnold G, Lempert T (2001) The interrelations of migraine, vertigo, and migrainous vertigo. Neurology 56(4):436–441CrossRefPubMedGoogle Scholar
  10. 10.
    Headache Classification Subcommittee of the International Headache Society (2004) The international classification of headache disorders: 2nd edition. Cephalalgia 24(Suppl 1):9–160Google Scholar
  11. 11.
    Vitkovic J, Paine M, Rance G (2008) Neuro-otological findings in patients with migraine- and nonmigraine-related dizziness. Audiol Neuro-Otol 13(2):113–122CrossRefGoogle Scholar
  12. 12.
    Murray K (2005) Incidence, assessment and management of vestibular dysfunction, (Doctoral disertation). The University of Melbourne, MelbourneGoogle Scholar
  13. 13.
    Jacobson GP, Newman CW (1990) The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 116(4):424–427CrossRefPubMedGoogle Scholar
  14. 14.
    Jorstad EC, Hauer K, Becker C, Lamb SE (2005) Measuring the psychological outcomes of falling: a systematic review. J Am Geriatr Soc 53(3):501–510CrossRefPubMedGoogle Scholar
  15. 15.
    Morris AE, Lutman ME, Yardley L (2009) Measuring outcome from vestibular rehabilitation, part II: refinement and validation of a new self-report measure. Int J Audiol 48(1):24–37CrossRefPubMedGoogle Scholar
  16. 16.
    Franchignoni F, Tesio L, Martino MT, Ricupero C (1998) Reliability of four simple, quantitative tests of balance and mobility in healthy elderly females. Aging Clin Exp Res 10(1):26–31Google Scholar
  17. 17.
    Tyson SF, Connell LA (2009) How to measure balance in clinical practice A systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions. Clin Rehab 23(9):824–840CrossRefGoogle Scholar
  18. 18.
    Vereeck L, Wuyts F, Truijen S, Van de Heyning P (2008) Clinical assessment of balance: normative data, and gender and age effects. Int J Audiol 47(2):67–75. doi: 10.1080/14992020701689688 CrossRefPubMedGoogle Scholar
  19. 19.
    Wrisley DM, Marchetti GF, Kuharshy DK, Hitney SL (2004) Reliability, internal consistency, and validity of data obtained with the Functional Gait Assessment. Phys Ther 84(10):906–918PubMedGoogle Scholar
  20. 20.
    Murray K, Carroll S, Hill K (2001) Relationship between change in balance and self-reported handicap after vestibular rehabilitation therapy. Physiother Res Int 6(4):251–263CrossRefPubMedGoogle Scholar
  21. 21.
    Murray KJ, Hill KD, Phillips B, Waterston J (2007) The influence of otolith dysfunction on the clinical presentation of people with a peripheral vestibular disorder. Phys Ther 87(2):143–152CrossRefPubMedGoogle Scholar
  22. 22.
    Spielberger CD (1983) State-trait anxiety inventory for adults sampler set manual, tests, scoring key. Mind Garden, Redwood City, CAGoogle Scholar
  23. 23.
    Powell LE, Myers AM (1995) The activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci 50A(1):M28–M34CrossRefPubMedGoogle Scholar
  24. 24.
    Morris AE, Lutman ME, Yardley L (2008) Measuring outcome from Vestibular Rehabilitation, Part I: qualitative development of a new self-report measure. Int J Audiol 47(4):169–177CrossRefPubMedGoogle Scholar
  25. 25.
    Black FO, Angel CR, Pesznecker SC, Gianna C (2000) Outcome analysis of individualized vestibular rehabilitation protocols. Am J Otololaryngol 21(4):543–551Google Scholar
  26. 26.
    Difabio RP (1995) Sensitivity and specificity of platform posturography for identifying patients with vestibular dysfunction. Phys Ther 75(4):290–305Google Scholar
  27. 27.
    Kammerlind A-S, Larsson P, Ledin T, Skargren E (2005) Reliability of clinical balance tests and subjective ratings in dizziness and disequilibrium. Adv Physiother 7(3):96–107CrossRefGoogle Scholar
  28. 28.
    Hill KD (1996) A new test of dynamic standing balance for stroke patients: reliability, validity and comparison with healthy elderly. Physiothe Can 48(4):257–262CrossRefGoogle Scholar
  29. 29.
    Giorgetti MM, Harris B, Jette A (1998) Reliability of clinical balance outcomes measures in the elderly. Physiothe Res Int 3(4):274–283CrossRefGoogle Scholar
  30. 30.
    Wrisley DM, Walker ML, Echternach JL, Strasnick B (2003) Reliability of the dynamic gait index in people with vestibular disorders. Arch Physi Med Rehabil 84(10):1528–1533CrossRefGoogle Scholar
  31. 31.
    Furman JM, Marcus DA, Balaban CD (2003) Migrainous vertigo: development of a pathogenetic model and structured diagnostic interview. Curr Opin Neurol 16(1):5–13CrossRefPubMedGoogle Scholar
  32. 32.
    Yardley L, Beech S, Zander L, Evans T, Weinman J (1998) A randomized controlled trial of exercise therapy for dizziness and vertigo in primary care. Br J Gen Pract 48(429):1136–1140PubMedGoogle Scholar
  33. 33.
    Herdman SJ, Clendaniel RA, Mattox DE, Holliday MJ, Niparko JK (1995) Vestibular adaptation exercises and recovery—acute stage after acoustic neuroma resection. Otolaryngol Head Neck Surg 113(1):77–87CrossRefPubMedGoogle Scholar
  34. 34.
    Herdman SJ, Schubert MC, Das VE, Tusa RJ (2003) Recovery of dynamic visual acuity in unilateral vestibular hypofunction. Arch Otolaryngol Head Neck Surg 129(8):819–824CrossRefPubMedGoogle Scholar
  35. 35.
    Hain TC, Uddin M (2003) Pharmacological treatment of vertigo. CNS Drugs 17(2):85–100CrossRefPubMedGoogle Scholar
  36. 36.
    Waterston J (2000) Neurology. 3: dizziness. Med J Aust 172(10):506–511PubMedGoogle Scholar
  37. 37.
    Katzenell U, Segal S (2001) Hyperacusis: review and clinical guidelines. Otol Neurotol 22(3):321–326CrossRefPubMedGoogle Scholar
  38. 38.
    de Tommaso M, Valeriani M, Sardaro M, Serpino C, Di Fruscolo O, Vecchio E, Cerbo R, Livrea P (2009) Pain perception and laser evoked potentials during menstrual cycle in migraine. J Headache Pain 10(6):423–429. doi: 10.1007/s10194-009-0150-2 CrossRefPubMedGoogle Scholar
  39. 39.
    Kelman L (2004) Osmophobia and taste abnormality in migraineurs: a tertiary care study. Headache 44(10):1019–1023CrossRefPubMedGoogle Scholar
  40. 40.
    Morrison DP (1990) Abnormal perceptual experiences in migraine. Cephalalgia 10(6):273–277CrossRefPubMedGoogle Scholar
  41. 41.
    Merfeld DM, Priesol A, Lee D, Lewis RF (2010) Potential solutions to several vestibular challenges facing clinicians. J Vestib Res-Equilib Orientat 20(1–2):71–77Google Scholar
  42. 42.
    Lewis RF, Priesol AJ, Nicoucar K, Lim K, Merfeld DM (2011) Abnormal motion perception in vestibular migraine. Laryngoscope 121(5):1124–1125. doi: 10.1002/lary.21723 CrossRefPubMedGoogle Scholar
  43. 43.
    Aurora SK, Wilkinson F (2007) The brain is hyperexcitable in migraine. Cephalalgia 27(12):1442–1453CrossRefPubMedGoogle Scholar
  44. 44.
    Judit A, Sandor PS, Schoenen J (2000) Habituation of visual and intensity dependence of auditory evoked cortical potentials tends to normalize just before and during the migraine attack. Cephalalgia 20(8):714–719PubMedGoogle Scholar
  45. 45.
    Best C, Tschan R, Eckhardt-Henn A, Dieterich M (2009) Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder? Neuroscience 164(4):1579–1587CrossRefPubMedGoogle Scholar
  46. 46.
    Best C, Eckhardt-Henn A, Diener G, Bense S, Breuer P, Dieterich M (2006) Interaction of somatoform and vestibular disorders. J Neurol Neurosurg Psychiatry 77(5):658–664CrossRefPubMedGoogle Scholar
  47. 47.
    Eckhardt-Henn A, Best C, Bense S, Breuer P, Diener G, Tschan R, Dieterich M (2008) Psychiatric comorbidity in different organic vertigo syndromes. J Neurol 255(3):420–428CrossRefPubMedGoogle Scholar
  48. 48.
    Jeong SH, Oh SY, Kim HJ, Koo JW, Kim JS (2010) Vestibular dysfunction in migraine: effects of associated vertigo and motion sickness. J Neurol 257(6):905–912. doi: 10.1007/s00415-009-5435-5 CrossRefPubMedGoogle Scholar
  49. 49.
    Kinnealey M, Fuiek M (1999) The relationship between sensory defensiveness, anxiety, depression and perception of pain in adults. Occup Ther Int 6(3):195–206CrossRefGoogle Scholar
  50. 50.
    Last CG, Hersen M (1988) Handbook of anxiety disorders. Permagon Press, New YorkGoogle Scholar
  51. 51.
    Engel-Yeger B, Dunn W (2011) Relationship between pain catastrophizing level and sensory processing patterns in typical adults. Am J Occup Ther 65(1):e1–e10CrossRefGoogle Scholar
  52. 52.
    Neal JA, Edelmann RJ, Glachan M (2002) Behavioural inhibition and symptoms of anxiety and depression: is there a specific relationship with social phobia? Br J Clin Psychol 41:361–374CrossRefPubMedGoogle Scholar
  53. 53.
    Jerome EM, Liss M (2005) Relationships between sensory processing style, adult attachment, and coping. Pers Individ Dif 38(6):1341–1352. doi: 10.1016/j.paid.2004.08.016 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Jessica Vitkovic
    • 1
    Email author
  • Arimbi Winoto
    • 2
    • 3
    • 4
  • Gary Rance
    • 1
  • Richard Dowell
    • 1
  • Mark Paine
    • 5
  1. 1.Department of Audiology and Speech PathologyThe University of MelbourneCarltonAustralia
  2. 2.Department of AudiologyThe Royal Victorian Eye and Ear HospitalEast MelbourneAustralia
  3. 3.Dizzy Day ClinicsMelbourneAustralia
  4. 4.Austin Health HeidelbergHeidelbergAustralia
  5. 5.Department of Neuro-OpthalmologyThe Royal Victorian Eye and Ear HospitalEast MelbourneAustralia

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