S6:Ep3 – Conquering Dizziness: Everything You Need to Know About Vestibular Symptoms, Vestibular Migraine, and How to Manage

Voice-over: Welcome to Spotlight on Migraine hosted by the Association of Migraine Disorders. In this episode of Spotlight on Migraine, vestibular physical therapist, Dr. Madison Oak, provides us with information about the vestibular system and vestibular therapy. She talks about common vestibular symptoms, including dizziness, vestibular migraine, and offers strategies for how to cope.

Molly O’Brien: Hello, and welcome to Spotlight on Migraine. I’m your host, Molly O’Brien. Whether you experience vestibular migraine or experience vestibular symptoms during a migraine attack, dealing with dizziness and these other symptoms can be tough and trust me, I know, I’ve been there. So today we’re going to talk about the vestibular system, vestibular symptoms, and how we can manage them.

I’d like to introduce and welcome our guest, Dr. Madison Oak. You might recognize or know Dr. Oak better as the vertigo doctor on Instagram. Madison has her doctorate in physical therapy. She’s the owner/CEO and practicing physical therapist at Oak Physical Therapy and Wellness. She provides virtual vestibular physical therapy services and group coaching and wellness sessions to patients, and she specializes in complex vestibular rehabilitation therapy.

Dr. Madison Oak, thanks so much for joining us today.

Dr. Madison Oak: Absolutely, I’m really excited to be here.

O’Brien: All right so before we jump in to talking about vestibular symptoms, dizziness, and ways we can help manage those symptoms, can you give us just a brief overview of what the vestibular system is? What is it? How does it function?

Oak: Yes, I will do my best to be as fast as humanly possible with this. So, your vestibular system is a part of your ear. You have three sections when you think about your ear. You have your outer ear, which is the part you can like touch and feel. You can stick your finger in there but are not supposed to, and that goes until you get to your eardrum. Your eardrum is what separates your outer ear from your middle ear.

Now your middle ear is the part that pops on an airplane, it pops if you scuba dive or dive in a pool or land in an airplane, right? That is supposed to happen; that’s called your eustachian tube. If you look at a map of the United States, it kind of…you can compare it to like Florida. It sort of looks like that in a photo. Now at baseline, it’s closed all the time – it’s supposed to be closed – and when you pop your ear, it opens and shuts again in order to regulate the amount of pressure and volume of air in the little sac that is your middle ear.

Now it houses pretty much air and three bones called your malleus, incus, and stapes, which you probably have not thought about since middle school biology class. And they hit against each other and send vibrations so you can hear this now. It’s part of your hearing system. They send vibrations through that middle ear to your inner ear. So it goes from your eardrum, three little bones, inner ear, aka your cochlea.

Now there are two parts of your inner ear; your cochlea is the other part you probably haven’t thought about since middle school biology class. But attached to it is its evil twin sister, the vestibular system, how your vestibular system can then be broken down into two more parts. So again, if you Google it, a little snail-looking thing that is your cochlea. And then the other weird canal-looking thing that is your vestibular system.

Now your vestibular system in two parts so you have three semicircular canals. And the three semicircular canals are what detect angular motion. So if you spun a circle, as a kid, right and you spun and spun and spun and laid down on the grass and looked up at the sky, the clouds would start to go by, right? They’d moved, they’d go by faster. And you’re like oh that’s kind of fun, right, you can watch them go by. That’s not so fun as we age because we stop doing it.

But that is what detects your angular motion. So spinning, lying down at an angle, all that good stuff. Your otolith organs, your utricle and your saccule – all these have ridiculous names – your utricle and your saccule that is what determines where you are linearly. So if you move forward, backward, side-to-side, left/right, up/down, all those types of movements, those are what are detected by your otolith organs.

Now there’s some anatomy in that we could go into, but it would take me much longer to explain. But basically what happens is all day every day, 365, your vestibular system sends a signal saying I’m looking forward, I’m looking forward, I’m looking forward at the exact same rate on both sides, your right and your left. When you turn and look to the right, the right side fires more, and the left side fires less.

And it says okay, I’m looking to the right and to the left kind of like this all day long. And that signal is transmitted from your vestibular system through the vestibular nerve to your brain. So you can almost imagine it as like a cable box receiving a signal, sending it through the cable to your television – your television being your brain – which makes a pictureish of where you are in space to attract acceleration, deceleration, where you are, lots of different things.

It communicates with your other balance systems, your proprioception, which is the way you feel the world, it’s how you know if your arm is straight or your arm is bent even if your eyes are closed. And it’s also how you know if you’re on grass or on concrete. And then it also will communicate with your vision system. So these three systems of balance triangularly in order to keep us upright.

O’Brien: There’s a lot of intricacy with our vestibular system. When we feel symptoms, does that just simply mean something’s out of whack?

Oak: Sure. So it can, and it also cannot mean that. So dizziness…

O’Brien: Never an easy answer.

Oak: …lightheadedness – never an easy answer – all of these different symptoms come from vestibular disorders. Now broadly, they can be separated into two different types. If we’re just talking about just vestibular disorders – we won’t bring like pops and things into it, which is like a whole other ballgame – but if you have a vestibular disorder, you can either have a central vestibular disorder meaning it’s happening your brain and spinal cord.

Since you are a Migraine Disorder Association, vestibular migraine is one of those central disorders. A peripheral vestibular disorder would be something like vestibular neuritis, which is an infection in your inner ear, and that will cause damage to the inner ear itself, which will make one of those signals that I was talking about before with my hand that if you’re watching us I guess then that will inhibit that signal.

But if you have a central vestibular disorder, like vestibular migraine, for example, then you’re going to have difficulty processing that information rather than sending that information. So for people with vestibular migraine, there’s typically – not always – but typically nothing wrong with the vestibular system itself. What’s going on is a processing problem in your brain. And you can have multiple vestibular disorders but, of course, that’s a whole different conversation.

O’Brien: Which is layer them on, layer them on. Awesome. Well thank you for helping make it a little bit more clear for what’s actually happening when we experience these symptoms. When you talked about spinning around as a little kid and laying down, that actually made me feel nauseous just hearing about it because when I deal with dizziness, man it is rough. But there are many other vestibular symptoms that people experience. We oftentimes think of dizziness, vertigo that kind of thing. But can you tell us just briefly about some of the most common vestibular symptoms people experience?

Oak: Absolutely. So, vertigo is a really common experience. But I think it’s also one of the symptoms that we most often inaccurately represent when we are presenting our symptoms, and that is because vertigo has a very specific definition. The definition of vertigo is the incorrect perception that you or the room around you is moving, sliding, or spinning. And so what that means is that I feel like internally I am rocking and swaying even when I’m not. That’s internal vertigo. Or I’m physically seeing the room spin because I’m having external room- spinning vertigo. So those are two different things but both types of vertigo.

Feeling lightheaded, feeling off, feeling imbalanced, like mud is sliding around in your head, like you have a hot air balloon for a head, things like that, those things are not vertigo, but they can be classified as dizziness. So all vertigo is dizziness, but not all dizziness is vertigo.

So dizziness is this big umbrella term for lots and lots of different symptoms. And I have had people, who have peripheral neuropathy who are having trouble balancing because they can’t feel their feet very well and that signal isn’t being sent, describe the imbalance as dizziness. And so if you are dizzy and you tell your healthcare provider – whether it’s a PT, an MD, whoever it is – I feel dizzy. Their next question needs to be, what does that feel like?

And so many people say to me, I feel crazy, but this is how I feel. Or I don’t know how to describe this, but maybe it’s like My Little Pony is dancing around in my head. Like that is not a crazy thing to say. That is my expectation of what you’re going to say because it’s a diffuse, bizarre set of symptoms that a lot of providers don’t understand but need to be asking these types of questions.

It’s sort of like saying, hey, I have pain. That’s not helpful for a healthcare provider, right? It’s like, what does that mean? Do you have stabbing and shooting? Is it dull and achy? Is it going for a long time? For a short time? All of these different things is what happens when someone says, I have pain, and the same thing goes for dizziness. So again, dizziness, big umbrella term, all symptoms can go underneath there, but vertigo is very specific.

O’Brien: I feel like that’s a really important point for folks dealing with vestibular symptoms because the better off you can describe what you’re experiencing, the better off you can approach treatment, you can communicate with your provider, whoever that is. So that’s super helpful to kind of have a clarification.

So let’s talk just briefly a little bit about vestibular migraine and vestibular symptoms. So some people experience vestibular symptoms during a migraine attack, and some people have vestibular migraine. Those two are different. So can you tell us how vestibular migraine presents?

Oak: So, vestibular migraine needs 5 minutes to 72 hours. And I will caveat this with we actually need a better diagnostic criteria, and I believe someone is working on that. That is above my above my grade as a human. Like I’m not on that committee, but I know that someone likely is, though. That is what I want to caveat.

But you need 5 minutes to 72 hours of vestibular symptoms accompanied by another migraine symptom. So that does not mean you need head pain. Most of the patients actually have never experienced head pain at all, but they have vestibular migraine. I think it’s about 40% of people with VM don’t have head pain. But you do need, again, a different migraine symptom.

So, people will say, I feel dizzy and have light sensitivity. Now dizziness and light sensitivity can come with lots of different things. So then you really have to get into, like, is there an attack period, right? Is it chronically happening? Do you have daily attacks? There are really a lot of nitty-gritty, just like all things in migraine, right?

But it’s 5 minutes to 72 hours of a vestibular symptom. So it can be vertigo. It can also be lightheadedness. It can also be imbalance. It can be any of those things. It can happen every day. It can cause chronic symptoms similar to how a lot of people who have painful migraine will have chronic head pain similar to that.

So if you are thinking about like do I have VM, think about does my dizziness accompany my migrainous symptoms at the same time? Now, I know this gets complex with do I have vertigo and dizziness that’s associated with my migraine, or do I have vestibular migraine? And that is something that I, as a physical therapist, cannot tell you but, hopefully, your headache specialist will be able to differentiate between that with you.

I do think that it’s generally considered, at this point, that those people will have on the spectrum of vestibular migraine. So I have patients who have a classic migraine attack, where they have head pain and light sensitivity and noise sensitivity one day, and then the next day or two days later, or whatever, they will have a vestibular migraine attack. No pain at all, just dizziness and, let’s say, light sensitivity for argument’s sake.

So you can have different attacks on that spectrum on different days on different times. And some people will say, when I get super stressed out, I get a painful migraine attack. But when my hormones are shifting because of my menstruation cycle, I get a vestibular attack. And why does [cuts out 13:02] this happen? Who knows, but we do know that that can present that way.

O’Brien: Like we were saying earlier, there’s never an easy answer when it comes to migraine. It just isn’t. The more I learn, the more fascinated I am, and also it’s like, oh, what are we supposed to do? But we’re going to get there.

Oak: Totally. We’re going to get there.

O’Brien: We’re going to get there. We’ll talk about some things you can do because there are, thankfully. So, you provide physical therapy, you provide group therapy, you have a whole host of resources that you specialize in. So let’s talk a little bit about vestibular therapy or vestibular rehabilitation. That’s an option for some people. Can you just tell us what vestibular therapy is?

Oak: Yes. So vestibular therapy is typically done by a physical therapist. Now I am a physical therapist. I have a clinical doctorate in physical therapy. And when you graduate from physical therapy school, they say, okay you can treat whatever you want. It’s not like when you go to med school and you’re like, okay, you’re a pediatrician, and you [cuts out 14:04] do anesthesiology, right? You are an orthopedic surgeon, and you do surgery only on knees. It’s not like that when you graduate PT school. You can treat whatever you want. I never want to see a hip, a back, a knee again in my life. All I want to see is people who have dizziness.

And I discovered vestibular rehab during one of my clinical rotations. We don’t get paid for these rotations, and so I needed somewhere free to live. Austin, Texas had a free place for me to live, through some family, and I was like, I’ll go wherever that is. Whatever clinic you have in Austin, I’ll go. And 360 Balance, and I think it’s called Balance & Dizziness, now, in Austin, Texas is where I had my internship. And all day, every day for 9 or 10 weeks, at the time, I just did vestibular rehab, and I was like, this is fascinating.

What it basically means is…and you should have someone who over 50% of the time treats vestibular disorders if you’re going to go see someone for vestibular rehab. You would never go to a cardiologist for a neurology problem, right? You would never go to a neurologist for knee surgery. You want to go to a vestibular therapist for vestibular rehab. And I want to be very specific about that because a lot of people will be like, well, I went to vestibular rehab, and I did 10 sit-to-stands and then 30 calf-raises, and I didn’t get better. Like that’s not vestibular rehab.

Vestibular rehab intends to rehabilitate your inner ear and help you with functional and lifestyle changes in order to help manage your vestibular disorder. Now, there are many vestibular disorders, and if you want to learn more about those, I have a podcast called Grounded, and you can go listen to all of them there. We only have time to talk about migraine today.

I mostly treat migraine and something called persistent postural perceptual dizziness, which I sort of compare to like the chronic pain of dizziness. It’s a chronic dizziness disorder. And basically, the two of those need functional, lifestyle changes rather than so much head-shaking exercises.

The basis of vestibular rehab is to help you with motion sensitivity, to help you stabilize your gaze if your gaze is bouncing while you’re walking, through some sort of body movement, head movement, and balance exercise. It also helps your balance. Vestibular rehab does a lot of fantastic things. I’m a big fan. I’m a vestibular rehab therapist by practice.

That all being said, if you have vestibular migraine, and if you are listening, that is very possible, and you have been to vestibular rehab, and it made you worse, you are not alone. I’m not saying it makes everyone worse. It makes a lot of people feel a lot better.

But if we talk about migraine as a threshold disorder…which we all kind of can agree that it is, right?…a lot of time this style of like shake your head back and forth and make you dizzier exercise at first can make you feel a lot worse. Because if you have just been diagnosed with vestibular migraine or gotten to the point with your VM where it’s more chronic, or more debilitating, and the symptoms are getting worse, and then you start to shake your head, that can make you feel a lot worse.

So what I recommend doing instead is talking to your physical therapist about what are the things that I can do to manage my vestibular migraine disorder in order to get to the point where I then can do these types of exercises.

So again, vestibular rehab therapy is a balance and vestibular rehabilitation program that involves head movement, head shaking, eye movement, eye convergence and divergence, it requires balance on different surfaces, walking with head turns, all kinds of like the weirdest maneuvers of all time that you’re like, why are we doing this? It’s just so bizarre.

But in general, I find if you can have a therapist who not only is a vestibular therapist but actually understands how migraine works…or how we think, at this point, migraine works, right? We don’t really know why it happens exactly. But the research that we do know, and they’re up on the research, that’s really what you want to look for if you have vestibular migraine, and you’re going to a vestibular clinic.

Because again, we do not want your symptoms to get a lot worse during rehab. It should get worse for about 10 to 15 minutes, and then you should be able to bring them right back down to baseline. This should not ruin your day. This should not last an hour and a half. This should not last one week. It shouldn’t trigger an attack.

If that is the case, you say, okay, I’ve done too much, I’ve done it too quickly, I need to take a step back and maybe even build my threshold before I go to vestibular rehab. So I hope that answers your question a very long-winded way.

O’Brien: Absolutely. And you kind of touched on this, but how does someone know if vestibular rehab or vestibular physical therapy is right for them? You sort of touched on it but just a refresher.

Oak: So the basics of when you should always go to VRT is if you have BPPV, which is benign paroxysmal positional vertigo, which is the most common cause of vertigo. It’s the type of vertigo that you will lay down and the room will…it’ll be delayed, but the room will spin for 15 to 60 seconds, and then it will stop spinning until you move again, basically. And if you have that kind of vertigo, I always recommend heading to the physical therapist. You can pretty much see any physical therapist for that. We all should learn that in school. So that always.

If you have vestibular migraine, you are more likely to get BPPV. But also you should know if you have vestibular migraine and the maneuvers are not working, vestibular migraine can present identically to BPPV, and so, sometimes, doing 100 Epley maneuvers or canalith-repositioning maneuvers is not going to be helpful. So talk to your doctor about that. If you have vestibular neuritis, the inner ear infection, you should always head to VRT within three or four days. That’s the fastest way to recover.

And then if you feel like, okay, I have vestibular migraine, I have it relatively well-managed. And by that, I don’t mean you’re never going to have an attack again. By that, I mean like when you have an attack, you know what to do, you have some sort of a rescue medication, abortive medication, something in that realm. You know how to manage your symptoms, things like that. And you understand, okay, if I move my head right and left a couple of times, I don’t go into a full-blown dizzy flare. That’s sort of when, okay, maybe you’re ready. And again, take it super slow.

There’s like a whole thing in PT about underdosing and, like, you never want to underdose your patient because it’s just doing them a disservice. I don’t believe in that in vestibular rehab. Because you would rather do not enough, and I’d rather have my patients say, you know what, I didn’t really make a big change this week or in two weeks…I didn’t really make a huge change, but I didn’t have a massive flare from these exercises, right?

Because you’re adding to that bucket every time you go and do those exercises. You’re adding a little bit with the intention that you’re going to build that threshold. But you’re adding a little bit to that threshold all the time. And so we want you to feel like, okay, I can add just enough to my cup without going over, without the rest of my day going over. And there’s things about rest and putting enough slack in your system and stuff like that as well. But it shouldn’t make you feel worse.

So if your therapist gives you just a little bit of stuff at first, and then, in the future, they start to give you more and more, that’s better than being like, here’s 45 minutes of exercises, and then you’re dizzy for four days. That’s just not helpful.

O’Brien: I mean, I get the concept, but when it comes to vestibular symptoms, no, that’s not helpful. That makes you way worse.

Oak: 100%. 100% not helpful.

O’Brien: No, not helpful. Let’s talk just briefly, too, about some of the techniques used in physical therapy. You’ve talked a little bit about the Epley maneuver, which might be right for some people. You’ve talked about head-turning exercises, eye-movement exercises. What are some other techniques that you use when dealing with patients who have vestibular symptoms, vestibular migraine or otherwise?

Oak: Honestly, with all of my vestibular migraine patients, I start with like the four pillars of [cuts out 22:21] what I have found make people actually feel better long term. And I do the same thing in my group program, which is called vestibular group. It is the identical method I use in one-on-one therapy, which is great because it is a fraction of the cost and super accessible internationally.

So what those four are are movement, mindset, support, and education. So first you have to understand what is going on in your body. Most people with vestibular disorders, especially with vestibular migraine, have been gaslit that they have been making up their symptoms for over 20, 30 years. It is mind-boggling to me. That is a conversation for another time. But it is so common for someone to have told you, hey, you are making this up. This isn’t real. It’s just anxiety. XYZ. It’s almost never just anxiety. Like I’ve seen maybe three people where like this is actually anxiety. It’s not. It is usually vestibular migraine.

So understanding what migraine is, finally getting a handle on that, and then like what are the basics that I need to know? We need to stay hydrated, right? Electrolytes and salt are not going to cure your migraine disorder, but it is something that can…and water.

O’Brien: We know what you mean.

Oak: Electrolytes and water are not going to cure anything, right? But there are things that are going to be helpful in managing this disorder.

Eating every few hours, keeping your blood sugar stable. How do we do mindfulness and breath work practices? A lot of dizziness is going to make you anxious. This is not your fault. This is super, super common. But what are the things we can do to calm down our nervous system? Because at baseline, like this is a nervous system dysfunction, basically.

And so what are the things we can do to help regulate our nervous system? I call them the kind of the basics. So breathing, eating, drinking water, starting to move your body a little bit, super, super gently. That’s where we start in order to kind of raise that threshold and build you a bigger bucket for triggers to go in. That’s the educational aspect.

Of course, getting support is really, really, really important. We have a group that everyone can be in which is focused on kind of what you can do and asking questions about like things like showering is really difficult for me. Like how do I make this easier? Things like that.

And then the movement piece is super important, we know. I know you guys, I think, had a podcast or blog on this recently about how important exercise is for people who have migraines. It’s really, really important, but it does need to be done right. You can’t just out of the gate tomorrow run a marathon. You’re probably going to make yourself worse, right? And so that’s not your fault, but that is something to know, right? It’s something to be aware of ahead of time that we need to be able to scale.

So there is the whole thing about scaling, I always tell people, please, please, please start with three or five minutes maximum at first, then you’re going to slowly work your way up. So movement is going to be a really big part of that.

And then your mindset, the way that you think about dizziness. And I will never claim to be a cognitive behavioral therapist. That is not my lane. But I’m excellent at teaching critical thinking. And the way that you think about your vestibular symptoms is incredibly important. And this is a hard one. This mindset shift is difficult, but when people make it, it is life changing.

So we think about, like…I don’t even have a good example. But the way, basically, that you can think about your symptoms. The way you can say, okay, I know that this might happen again, these are the things that I’m going to try next time it happens, and then that gives me some form of control is really helpful.

So I’m not just talking like, I’m just going to try just breathing next time. Like, let’s build you a whole toolkit in order to wrap your head around the fact that this is indeed happening. It doesn’t mean you’re going to be dizzy every day, forever. It is not true. There aren’t cures.

That doesn’t mean you’re going to be dizzy every day. It does mean you can manage this. It does mean, hey, I know if I accept that this is happening inside my body, I can indeed find ways to manage this in the future. So those are kind of the pillars that I start with.

And then after people can kind of get down that routine…and it takes time. That’s normal, and that’s good, and that’s okay…and really practice that, then we can be like, okay, is your gaze still unstable? Like do things bounce when you walk or when you run? If yes, then, okay, we can find ways to help start managing that and doing some head-shaking exercises.

I generally say that balance exercises are kind of pretty safe overall, and I can almost always prescribe those. But if those are making you super uncomfortable, you don’t necessarily need to start them yet. So that’s really a clinical decision that you need to make with your therapist.

But all of those things are also the vestibular group fit, which is kind of fun because vestibular rehab is really inaccessible. It’s hard to find vestibular rehab therapists that actually…whether we’re talking about staying up on the research and even harder to find one who treats vestibular migraine

So a concussion therapist is not a vestibular migraine therapist. I love concussion therapists, do not get me wrong, but it’s not the same thing. Dizziness doesn’t come from the same places in most cases. So it’s important to kind of understand who you’re going to see and making sure they know what they’re talking about.

O’Brien: And some of those ideas that you talked about briefly, like making sure you have adequate sleep and rest, making sure you stay hydrated, having movement incorporated into your day, making sure you have a consistent eating schedule, and then working on breathing, those are all things that people can do at home as well, which is really nice.

And we will obviously link out to your social, and we’ll make sure people know where to find your website, so if they’re interested in learning more as well because you do talk about this stuff a lot, which is super helpful, and in a very easy to digest way.

So as we kind of wrap up here, one of the things that our followers want to know the most about is how do we function and just do daily life when we have these vestibular symptoms?

I know about two months ago, I had a really bad attack where I was laid out and I was, like, what do people do when they experience this every day? You can’t drive. People want to know how you go to the grocery store. It’s really difficult to function when you’re in the throes of this.

But never fear, you have some advice and tips. So I’m wondering if you can share a couple strategies of how to just manage doing life when you’re in the throes of vestibular symptoms. A couple places are like the grocery store and driving. What do you do?

Oak: Those are huge. So those are two of the biggest complaints I get besides showering…actually, like the third and which is a big one. And honestly, those two are ones that we just have to work up to. There are a lot of components that go into driving and a lot of components that go into going to the grocery store.

One of the biggest ones is visual vertigo. And visual vertigo is basically your brain is over depending on your eyes and not depending enough on your inner ear for a signal. And this can happen in both central and peripheral vestibular disorders. But what is happening is your brain is interpreting everything that happens through your eyes as the truth.

So if something is moving past you, you are all of a sudden moving, rather than your vestibular system saying, hey, you’re moving or not moving, which is what’s supposed to happen. It’s supposed to work in a system of checks and balances.

So when this is actually happening if you can…Instacart is your friend. Drive-by pickup is your friend. Like kind of using the tools you have around you, which are not tools that just people with vestibular disorders use. Everyone on the planet uses Instacart and pickup and things like that. So if you have that resource available to you, I know that I personally, where I live, do not. But if you have that resource available, that is a great option.

Asking for help. Super, super helpful. Sometimes you just have to do these things, and it’s not fun. But if you can when this is happening, like, okay, I’m having a really bad day. Give yourself that day, just give yourself the day, rest as much as you humanly possibly can. I know it feels like the worst possible ever thing to do. But eat and stay hydrated. Just doing those things sort of like if you had the stomach flu, you would give yourself the day, right? You’d like, oh, I have the stomach flu. I can’t be going to the grocery store today. That’s not going to go well for me.

Now when this is happening once a week, it gets a little bit more difficult…or even daily, it gets more difficult. The best thing that you can possibly do is find the tools that work for you. So things like a weighted blanket to help you ground. Honestly, I do not have a relationship with these people. But the gammaCores and Cefalys of the world are super, super helpful on these days. Again, making sure you’re having enough water, staying hydrated, electrolytes if those work for you, and kind of getting yourself as close to your baseline as you possibly can, and then asking for help.

The other thing if this is like a chronic issue for you, this is happening frequently, right? Like having this once a year or once a month is much different than having this every couple of days, of course, and I’m completely privy to that. It’s going to take time to get you back to the grocery store. This is not like you’re going to do this, listen to me talk today and go to vestibular rehab tomorrow, and by Thursday, you’re going to be back at the grocery store. This is something that’s going to take time. So asking for help and pacing yourself as much as you can until then is really important.

I know we’re about to finish up. But the concept of pacing is really, really important. So understanding that if you have a hundred things to do today, make a list. Okay, what is the hundred things I have to do today? What are the three things that actually have to get done today? And how can I space those out? Charging your battery when it’s at 80% and not at 10% is so much easier than having to get 90% of charge, right? So if you can do one task, take a break, do one task, take a break.

Remind your body that you’re safe. Remind your body that you’re still. Because once you get dizzy, that anxiety is going to kick in that feeling of like this is never going to go away, this is going to be forever kicks in, and that just fans the flame which we know about pain neuroscience and dizziness neuroscience. So the more we fan that flame with that anxiety, which, again, is so hard not to do, it is so hard, but that’s where that big mindset shift comes in of I am safe, I am still, I’m okay, I’m going to be fine.

The Kelli Yates special…she’s the migraine dietitian. I steal this from her all the time…is it came, so it can go. And that’s a really good one to kind of tell yourself over and over again, even when it feels like, hey, this is never going to go away. It’s going to go away; it’s going to get better. But you need to give it time, you just scale, you need to pace.

And when you are ready to say, okay, I’m ready to start to do rehab, kind of do all these things to build this bucket which, again, I know it’s not always accessible 24/7, it’s not accessible to everyone, and it’s really hard. Once you are ready…giving yourself slack in the system, resting extra, sleeping extra, doing the things that like we need to be doing, which, again, most people are already doing these things. You just need kind of the right set of tools at the right time with the right resources all at the same time…will get you back to the grocery store.

But again, it’s not something that’s going to happen overnight. But if you absolutely have to go to the grocery store, get a cart, hang on tight, stare at the end of the aisle. Don’t scan. Once you get to like the tomato sauce or whatever, turn your whole body, decide what tomato sauce you want, turn your whole body back, and move like a robot. That’s not a long-term solution, but it’s a good short-term solution. Uber, Lyft, taxis are your friend for the driving.

O’Brien: Absolutely. Dr. Madison Oak, you have just changed the game. I tell you. This has been so awesome. So helpful. Like I said, I’ve dealt with dizziness, the nausea, the motion sickness. It is rough. So for people out there, I feel for you. I really appreciate you joining us today. I think my favorite thing too, the favorite, you snuck it in here, was use a weighted blanket so you feel grounded. That’s genius.

Oak: So good. Works like a charm.

O’Brien: You just got to dig it out.

Oak: So simple and works so good. You just have to dig it out. You can also use it in a car if you’re a person who gets to the stoplight and feel like they’re still moving forward, you can get like a sandbag or a weighted blanket to just put on your lap. It’s really helpful too for driving.

O’Brien: Oh my goodness. That is genius. All right, Dr. Madison Oak, before time runs out, I just want to say thank you so much for joining us for this episode on Spotlight on Migraine. It’s been a pleasure chatting with you.

Oak: Thank you so much for having me. It’s been my pleasure.

O’Brien: It’s been really a pleasure speaking with you today. If any of our followers out there want to know more about vestibular symptoms or how to manage them, you can check out Dr. Oak’s podcast called Grounded.

That wraps up this episode of Spotlight on Migraine. I’m your host, Molly O’Brien. We’ll see you next time.