Vestibular migraine (sometimes called migraine-associated vertigo) is a neurological condition characterized by recurring episodes of vertigo, spinning sensation, or dizziness. Unlike regular migraines, vestibular migraines occur with vertigo and other symptoms of the inner ear or balance issues. Vertigo associated with vestibular migraine can be severe and disabling. It can last from just a few minutes to hours.

Common symptoms of vestibular migraine include:
Vertigo: Sensation of spinning or whirling, often accompanied by unsteadiness or loss of balance.
Visual disturbances: Visual symptoms include blurred vision, visual aura (similar to the visual disturbances seen in classic migraines), and sensitivity to light (photophobia).
Nausea and vomiting: Similar to other migraines, vestibular migraines can cause gastrointestinal symptoms.
Headache: While not always present during a vestibular migraine episode, headaches can occur before, during, or after vertigo.
Sensory sensitivity: Increased sensitivity to light, sound, and even certain odors.
The cause of vestibular migraines is not fully understood, but they are thought to result from complex interactions between genetic predisposition, central nervous system dysfunction, and triggers that can set off a migraine episode.

Exercises to ease Vestibular migraines should be performed under the guidance of a qualified physical therapist or vestibular specialist – like Mary Carpenter at Synergy Physical Therapy in Spokane Valley. When you work with a therapist experienced in vestibular treatment, they’ll prescribe specific exercises, the intensity of which will be based on your condition and needs. These exercises are specially tailored to your symptoms and progress.

That being said, we’ve listed some common vestibular exercises below so that you understand what a vestibular treatment regimen might include. If you try any of the activities below and they disagree with you, take that as a sign that you should see Mary Carpenter – she’ll help you tailor your program for the best results at the safest pace.

Vestibular migraine exercises fall into the following categories:

a. Gaze Stabilization: Focusing on a stationary object while the head moves. These exercises help train the brain to process visual information more effectively during motion.
b. Balance Exercises: Activities that challenge balance, such as walking in a straight line, walking while turning the head from side to side, and standing on one leg.
c. Habituation Exercises: Gradually exposing the individual to movements that provoke dizziness or vertigo. These exercises help the brain adapt and reduce sensitivity over time.

Let’s start with Gaze Stabilization Exercises. These exercises require careful focus, so please remember the following when trying a gaze stabilization exercise. First, your visual target must remain in focus, not blurry. Second, it should be stationary while your head is in motion (e.g., don’t pick a branch that might sway in the wind). Third, starting with slight head movement (45 degrees on either side) is a good idea. Fourth, if you wear glasses, wear them while performing exercises. Finally, think safety first – stay seated or (if standing) support yourself with a counter or railing.

Vestibular migraine Exercises: Gaze Stabilization

Horizontal Gaze Stabilization: This exercise focuses on improving gaze stability while moving the head horizontally.

Instructions:
a. Sit or stand in a comfortable position. Keep your spine straight and shoulders relaxed.
b. Choose a fixed point or object in front of you at eye level. This could be a spot on the wall, a picture frame, or any other stationary object.
c. While keeping your head still, shift your gaze to the chosen point and focus on it.
d. Slowly turn your head from side to side, about 45 degrees to each side, while keeping your eyes locked on the fixed point.
e. Repeat this back-and-forth head movement for about ten repetitions.
f. Take a short break and then perform another set of ten repetitions.
g. As you become more comfortable with the exercise, you may gradually increase the head movement speed while maintaining focus on the fixed point.

Up-and-Down Eye Movements: This exercise helps improve gaze stability in the vertical plane.

Instructions:

a. Sit or stand comfortably with a straight spine and relaxed shoulders.
b. Choose a fixed point or object above you, such as a mark on the wall or a picture.
c. Keep your head still and focus your gaze on the chosen point.
d. Slowly move your eyes up and down as if you’re following the vertical path of the object.
e. Perform this eye movement for about ten repetitions.
f. Take a short break and then perform another set of 10 repetitions.
g. Gradually increase the speed of your up-and-down eye movements as you become more comfortable.

Gaze Stabilization is just one piece of the puzzle. Prescribed Vestibular Migraine exercises might include balance exercises. These balance exercises help you avoid a fall. They can also help you feel more confident, even during moments of dizziness. Two balance exercises that you might experience in a Vestibular Migraine exercise program are the following:

Vestibular migraine Exercises: Balance

Standing on One leg: This exercise challenges your balance by standing on one leg, helping to improve stability and coordination.

Instructions:
a. Find an open space where you can stand comfortably.
b. Begin by standing upright with your feet hip-width apart and your arms by your sides.
c. Choose a focal point or fixed object in front of you to help maintain your balance. Focus your gaze on this point.
d. Slowly lift one leg off the ground, bending at the knee, and bring your foot up toward your ankle, calf, or thigh. Find a position that is comfortable and allows you to maintain your balance.
e. Balance on one leg for about 30 seconds to 1 minute, or as long as you can comfortably manage.
f. If you start to lose your balance, gently tap your raised foot back down to the ground and regain your balance.
g. Switch to the other leg and repeat the exercise for the same duration.
h. Perform this exercise for several sets on each leg, gradually increasing the duration as your balance improves.

Tandem Walking: Tandem walking involves walking heel-to-toe in a straight line, which challenges your balance and coordination.

Instructions:
a. Find a clear and safe pathway where you can walk in a straight line.
b. Stand upright and take a step forward with one foot, placing the heel of that foot against the toes of the opposite foot (forming a “tandem” position).
c. Keep your arms extended to the sides or in front of you for balance.
d. Slowly move your back foot forward, placing the heel against the toes of the front foot. Maintain the heel-to-toe alignment.
e. Continue walking in a straight line, placing each foot in front of the other in a heel-to-toe fashion.
f. Aim to take about 20 steps this way, keeping your movements slow and controlled.
g. If you start to lose your balance, stop and regain your stability before continuing.
h. As you become more comfortable, you can increase the number of steps and the distance you walk.

Arguably, the most challenging exercises that might be prescribed in a Vestibular rehabilitation program are habituation exercises. These exercises involve choosing a movement or activity that triggers dizziness and repeating that activity until your vestibular system can become accustomed to the movement. These exercises are often uncomfortable and should initially cause dizziness. That’s why working with a qualified physical therapist is essential to identify the optimal activities and suitable pacing in your vestibular rehab therapy. Here’s what a habituation exercise might look like.

Vestibular migraine Exercises: Habituation

This exercise involves controlled head movements that may provoke dizziness, intending to reduce your sensitivity over time.

Instructions:
Sit or stand comfortably in a clear space.
Choose a specific head movement that you find slightly provoking, such as looking up and down or turning the head from side to side.
Perform the chosen head movement slowly and smoothly, repeating it for about ten repetitions.
Take a short break and then perform another set of 10 repetitions.
If you feel dizzy during the exercise, it’s okay. This exercises is intended to make you feel dizzy. Try to continue the movement while keeping your eyes open and focusing on a stationary object.
As you become more comfortable with the chosen head movement, try gradually increasing the speed or range of motion.
Over time, your brain may adapt to the movement, reducing the sensation of dizziness.

While vestibular migraine exercises are powerful, they’re just one part of a vestibular rehabilitation program. Along with exercises specially tailored to your symptoms and severity, your physical therapist can address the musculoskeletal often associated with vestibular migraine, which will usually lessen the dizziness you are experiencing. Your Synergy Physical therapist will also teach you about possible vestibular migraine triggers and how to make essential lifestyle changes. They’ll support you as you make the lifestyle changes that can lessen your symptoms.

If you’ve struggled with dizziness or debilitating vestibular migraines, you no longer need to suffer. Book an appointment with vestibular specialist Mary Carpenter today to regain hope and normalcy.