Voice-over: Welcome to Spotlight on Migraine, hosted by the Association of Migraine Disorders. Join us for fresh perspectives by medical experts and advocates as we explore the spectrum of migraine and dig deeper into this complex disease.
In this episode, vestibular audiologist and neuroplasticity therapist Joey Remenyi joins us to discuss how to change thought patterns using neuroplasticity to heal vestibular migraine and other conditions.
This episode is brought to you in part by our generous sponsors Amgen and Novartis.
Molly O’Brien: Hello, and welcome to Spotlight on Migraine. I’m your host, Molly O’Brien. I’d like to introduce our guest, Joey Remenyi. She’s a vestibular audiologist and a neuroplasticity therapist.
Joey, thanks so much for joining us.
Joey Remenyi: Thank you. It’s a pleasure to be here, Molly.
Molly: So vestibular migraine has been a hot topic, especially over here at the Association of Migraine Disorders. People really want to learn more. So we’ll start off with the very basics, and then we’ll go from there. So to start it off, what is vestibular migraine?
Joey: So you guys are all on board with knowing what migraines are. So it’s messages in the brain that are being disrupted in some way, and that can happen with various triggers, and it can be intermittent and episodic and all of these classic migraine features. However, vestibular migraine impacts the pathways from the inner ear — from the vestibular organs and the vestibular nerve pathways — and how those nerve pulses are traveling from the inner ear through the brain stem, midbrain, into the cortical areas of the brain, which means the symptoms may not include headache at all. Often people will say things like “cotton wool” or “pressure in my head” or just “brain fog,” so that hungover, drunken feeling, but they haven’t touched any illicit substances.
And it can really ruin a person’s life because it’s very invisible. It’s very difficult to understand. It comes and goes seemingly randomly. And it can take quite a few visits to the doctor before anyone’s talking any sense and starting to give answers or to consider this diagnosis.
So you’re welcome to pick my brain in any way, shape, and form, but most commonly, people will feel light sensitivity, sound sensitivity, possibly a disembodiment, like an astronaut out-of-body sensation, where it’s like they don’t necessarily have a strong sense of where up and down is or left and right. They may also feel spinning, push pull, up down, bobbing. It can be really, really disturbing. It’s almost like the world as you know it has been completely thrown out the window, and you’re living on this foreign, alien territory, and nothing makes sense anymore. But you look normal and healthy, so everyone’s like, “What’s wrong with you? Are you crazy?” And you’re like, “I don’t know. Maybe I am crazy.”
So it’s a very bizarre situation, and I think if it happened a few seconds or a few moments, it’s no big deal. But if it starts to become an ongoing, chronic issue, then anxiety, depression, self-esteem, body image issues — everything else cascades in. So it’s a big deal.
Molly: And it sounds frightening, the way you describe it. Obviously, we can’t see a person experiencing this attack. It’s not noticeable like that. But I know when I’ve had bouts of vertigo, I feel like the room is spinning. I’ve had one too many cocktails, like you mentioned, but haven’t had any cocktails. So that feeling can really be upsetting and confusing to people.
Joey: Yeah. I’ve actually had vestibular migraine symptoms myself, so I know firsthand. And I remember driving one day down a highway — exactly where you don’t want it to happen, because the car’s traveling really fast. But as you’ll learn about me, I have a really strong background in yoga and neuroplasticity, and I had all these skills and strategies I could use to help myself stay connected and keep it together. But I was actually in the car, and I felt stomach drop, so it was not just a feeling in my head or in my eyes.
Because this is the thing with vertigo is it can feel like I’m moving but the world is still, or it can feel like I’m still but the world is moving. So it’s a sensory conflict of some form, and the neural pulses coming from the ears don’t match what the eyes are seeing and what the body is sensing and feeling. And the part of the body we’re referring to is the proprioception, the touch.
So I’m sitting in the car, I can feel the seatbelt, I can feel the steering wheel, and that’s all giving me really good, solid, useful information that tells my brain, “I’m safe. It’s fine. I’m still on Planet Earth.” But my stomach’s dropping. I’m getting other sensory conflict and mismatch happening throughout other parts of my body.
I very frequently get visual distortion. That’s a really big one for me, which can be spotting, dotting, auras, or shifting, blurring movements. And that can also happen while my eyes are closed.
Molly: Wow. That sounds very frightening — one, to get an attack on the highway, and two, even when your eyes are closed, you’re not provided relief.
So we’ll get a little more into the basics of vestibular migraine, and then we’ll talk more about actions, which I know you’re going to help us out with. How can we tell if we’re having a vestibular migraine attack or maybe we’re just experiencing a bout of vertigo or something else?
Joey: Yeah, so I guess for vestibular migraine, it’s generally longer than 20 minutes. So most vertigos are very transient, and especially if it’s benign paroxysmal positional vertigo, which is the most common form of vertigo. I’ve also had that one twice, and I’m sure a heap of your listeners have had that one. And it’s actually very benign. That’s why it’s called benign paroxysmal positional vertigo. And it’s like usually you’ll get 10 seconds of your eyes moving, which is — the fancy word is nystagmus.
So if you were laying in bed, let’s say, and you had the BPPV arise, this vertigo, you’d actually see your alarm clock moving and spinning, which is what happened to me. Your eyes are actually moving. It comes and goes; it’s done. Definitely, if it goes on for longer than a minute, it’s no longer that condition. So it’s a quick — it’s over, and you can get on and live your day. You can actually return to normal between these little, very distressing bouts of vertigo, but they’re short and sharp. So that’s one way of knowing.
And then if it’s another condition, like a Meniere’s condition or a PPPD, they present differently as well. However, you can have both. You can have Meniere’s and vestibular migraine, which is relatively common. You can have vestibular migraine and PPPD. You can have BPPV and Meniere’s or vestibular migraine.
So the way I look at Meniere’s, which is a condition of the ear, is people can point to it. They’ll say, “I feel fullness, I hear ringing, and it’s right here.” They can localize it. For vestibular migraine, it’s very much in the head, and they’ll say, “I’ve got a heavy head. I’ve got pressure in my head. I’ve got eyestrain.” Or they’ll often say, “It’s at the base of the skull.” So they won’t be pointing to the ears. It’ll be more around the entire head region, and I think that’s a clue.
And also when we do our testing, vestibular migraine people often have normal test results, which can be so disillusioning because you’re like, “I feel awful. How on earth can I have normal results? Like, honestly. Get me a second opinion. Get me a third opinion.” And so it’s really frustrating. At least for other conditions such as Meniere’s, we can say, “There is a problem in this part of your ear. You’ve got hearing loss here. There’s been damage there.” And people can be like, “All right, well, that’s why I feel the way I feel.” It can be validating.
So, yes, it’s often normal MRI scan, normal hearing test, normal vestibular results, so everything’s coming up normal, but people feel really awful. And it can feel completely antisocial, to the point that they can’t work, they can’t take care of their kids, they might be afraid to drive their car.
Vestibular migraine can last for days. It can last for weeks. It can last for years. There will be rise and fall in intensity, and the book I’ve just written talks about how to really get the best recovery so that we can actually have 20 minutes of dizziness and then go back to a normal life, instead of that 20 minutes blowing out into a full week or a full month of feeling symptomatic.
So we can actually drive the symptom loops inadvertently, and that’s where we really want to come in and disrupt the neural patterns and bring that sense of balance back. And we have a lot of control over that, and that’s really the education and skills and tools that I use.
I no longer have vestibular migraine at all. I mean, it could come back — let’s face it — but it’s disappeared and it’s gone. So these are reversible, and I think it’s really important to have hope and to not feel as though there’s no cure and it’s doom and gloom. Because I feel like that’s not the way we have to look at it.
Molly: Definitely. And the way that you described each individual with be it vertigo or different types of vertigo or Meniere’s disease or vestibular migraine, I think you helped us understand a little bit more. So if we are experiencing some type of dizziness or what have you, the way you broke it down really helps interpret so we can understand what’s happening with our body. And, yes, being validated is so important, so I can see how that’s frustrating.
We want to talk a little bit now about what we can do about this, and you kind of touched on it, but we’ll continue on with that. So are there any ways — before we’re working to reduce our symptoms with vestibular migraine, we want to try to prevent it. Is there anything that you can do to prevent a vestibular migraine attack?
Joey: Yeah, and so I think it’s really important to remember that our body is seeking balance and equilibrium. And that was actually my favorite vestibular lecture when I was studying and I was at the University of Melbourne. And Dr. Joanne Enticott was lecturing, and she was like, “The body wants harmony. It wants homeostasis. It wants equilibrium.” It’s constantly searching to balance out, check all its boxes, and to make things feel easy breezy. And so a lot of healing and preventing is about supporting the body to do what it’s naturally very good at.
And I think what happens in modern-day life — and I’m guilty of this myself, and when my symptoms were worse, at their worst, it was a four-year period, and it did coincide with huge changes in my life and a lot of trauma and a lot of stress. Some of that was out of my control, and some of that was in my control, and it was a four-year journey of trying to wrap it all together and make sense of it and really come back to my own sense of center.
And the thing is, is as we change — so we’ve got physical sensations and symptoms and physical diet and physical exercise and physical medication options, and that’s often the route we take. So what can I physically do? And what I found to be more effective, actually, was the mental, emotional, spiritual aspects of healing, which is, What persistent thoughts am I having, and how are those thoughts leading to various chemical changes in my body? How is it impacting my hormonal cycles? How is that impacting the way my neurons fire? How are my thought patterns playing a role?
And I heard a medical doctor — she may have been a psychiatrist. I can’t remember; it was so long ago. She was a chronic-migraine sufferer, and she said, “I suffer from the shoulds.” She was like, “When I noticed how much I felt an obligation, and my whole life was really running in circles around what I thought I should do and should be and — the shoulds, the migraines were at their worst.” So actually having that awareness of the mental landscape changes the chemical and the physical byproducts.
Same with emotions — we need to have a sense of emotional fluidity, self-soothing, emotional regulation. Because what I notice in my vestibular migraine clients — and many of them have healed beautifully — honestly, it’s remarkable how they return to normal — is they’re having a lot of suppressed or unidentified emotions over their entire lifetime, so we could be going back to childhood. And they’re like, “Joey, I’m so healthy and well. Why would this come up now?”
And I’m like, Because you’re healthy and well, and your brain has had enough of suppressing it. It doesn’t want to — it’s clogging up the space. You couldn’t release that when you were eight years old or four years old or fifteen years old. But now you’ve got this maturity, and you are relaxed, and you are in a space where your brain’s like, “You know what? I want to release it now.”
And it’s through that releasing of suppressed emotions and understanding how we can support ourselves and feel through that so the body can kind of release, or what I would call “complete the chemical cycle.” It’s like we just put it aside — I’m not going to do that now. But when it’s ready, the body will release it, and then you kind of have to feel through it. I’m sorry. Feeling is healing. We can’t numb our way through this process.
But through that feeling and that self-inquiry and that self-support, people notice that often the migraine cycles begin to end. And that’s not a quick process, and it’s not a linear process. But I think it’s important to understand that emotional fluidity and being able to support ourselves and have self-compassion and navigate gently through self-acceptance and self-kindness — which is a huge part of the work I do with clients, and it’s a really big part of the book I wrote — that can be game changing.
And then spiritually — what I mean by that is — it has nothing to do with religious beliefs at all. Spiritually is really, What do I believe in? Do I believe my body can heal, or do I believe I’m stuck with this migraine forever? And am I giving my power away by buying that device, taking those drugs, going to see this doctor and that specialist and that masseuse and that osteo and that chiro? And I’m just constantly telling myself, “I can’t do this. Everybody else can heal, but I can’t heal.” And that’s actually coming down to a very deep belief system, probably embedded somewhere along the lines of, “I’m not good enough. I’m a failure. I’m inadequate. I’m not loveable.”
So this very gentle inquiry of going deeper and deeper and deeper into where these beliefs come from, when they started, and how I can begin to play a role in potentially updating them. And in my book, I talk about comparing it to a computer system update. The computer’s fine. You’ve had your MRI scan. you’ve had your ears tested. There’s nothing wrong with the hardware. So sometimes it’s that we’re living in belief systems and this mental emotional environment that suited us when we were eight or nine or ten, and we’ve actually outgrown it. So how do we do the software update? And often no one teaches us how to do that, right?
So it’s like we have to then go back to this pause, and often that’s what vertigo or tinnitus — which is the other symptom a lot of my clients have — it forces them into an almighty pause where they have to stop and take stock and say, “OK, no one else can fix me. I hate this. I’m completely stuck and debilitated. What are my options? How can I go within? How can I move towards feeling like I can actually heal this myself?”
Because my brain and body can change. I’ve read the science. I get it. Neuroplasticity’s out there. It’s not made up. How can I actually take steps towards believing that? And shifting a belief system is a pretty big deal. And then how can I take steps towards forgiving myself, being patient with myself, being kind to myself as I realize how I may not have been so kind to myself over the years and I may have participated to some of this inner conflict in my body? And how can I realize that that’s really normal, and Joey did it too, and probably all the other listeners on this program have done it too, and it’s OK because we’re all doing the best we can at any given moment.
And it’s through updating the software that we kind of have to eat a little bit of humble pie, but it kind of gets me the goosebumps and gives me the warm, fuzzy feelings, because on the other side of that feeling of kind of shame and “Oh my God, why have I been so hard on myself?” — the other side of that is, “I’m not going to be like that anymore. I’m going to be your friend. I’m going to support you. I’m going to hold you. I’m here for you” — this self-friendship, self-relationship, self-kindness. And that is amazing.
And so many of my clients will say how that changes everything. It changes their relationships, it changes how they parent, and a lot of them will begin to implement new boundaries for themselves so that they prevent relapse. They tighten up their inner world so that mentally, emotionally, and spiritually, there’s more alignment, there’s more peace, there’s more kindness, there’s more space for self.
And I’d love to hear what you perhaps have to say on this, Molly, but often people will say things like, “I felt selfish by putting myself first, and I was putting everybody else’s needs ahead of mine because I wanted to be a good mother, I wanted to be a good partner, I wanted to be a good employee. And so I was chasing my tail, running around, doing things that I thought I should do, being the person I thought I should be, because I just had to show up in the world in this way. And when I actually let that go and asked myself what I want and what I need and putting that first, everything changed.”
And that takes courage, actually, and it unfolds very differently for different people, which is why there’s no prescription or magic fix. But the path to get there will often be the reward in and of itself.
Molly: And it’s so true. It’s really hard to take that step and say, “I need to put myself first.” But if you care about other people, their feelings, their health and well-being, you can’t take care of anyone unless you’re taking care of yourself, so.
I do like the analogy of hardware and software of computers because that really does help us put it into perspective. Can we talk a little bit about neuroplasticity? Is there really a way that we can retrain our brains and heal ourselves internally?
Joey. Yeah. So if I use myself as an example, I used to have really distressing tinnitus sounds in my ears and in my head. It was awful. It was frightening. And I used to have the foggy, not quite right, pressure in my head, visual disturbances, everything. It’s like my brain was not working properly. And the reality was it was working perfectly for someone experiencing trauma and stress and for someone who was highly self-critical and probably perfectionistic and putting too much pressure on myself. And my brain was doing all the perfect things that I was telling it to do. So my brain was doing everything as a normal human being is designed, had all the fight, flight, freeze responses. They were operating 24 hours a day.
And so neuroplasticity’s about going, OK, this is how the brain works, this is how our nervous system works, this is how our emotions work, this is how the mental landscape works, and this is what I can do about it. And this is how my beliefs impact my biology. If I believe I’ve not good enough and I’m a bad mother and I’m a bad friend and I’m a bad person, that will impact my behaviors, my choices, my hormones, everything, right?
So everything’s interconnected and interrelated, which is why I take a holistic, whole-person, wholehearted approach. And I think the reason I get quite incredible results with my clients — and we do collect research, and it’s just mind-blowing — I think it’s because we teach people how to heal at their own pace in their own way. We’re not dictating, “OK, do this. Repeat it three times a day. Take this cocktail, and let’s review it in a month and see if it works.” It’s not this expert model saying, “Well, I’m going to fix you.”
When clients come to see me, I say, “You know what? I don’t know you. I have no idea what you’re feeling. I have no idea what you want to feel. And for you to change your brain, that’s the key recipe. We need to know, “What are you feeling right now, and what can you do to support that feeling?” so that the brain can chemically complete the process. If it’s feeling lonely, we need to complete that chemical release of loneliness, and then we need to support it with perhaps a feeling of connection, if that’s what the person wants.
And most importantly for neuroplasticity, we need to know what we want to feel. So I’ll give you another analogy, which may be helpful, is I think about every person has their little canoe and their little paddle, and this represents their life, their lifeboat, and their empowerment, their choices. They’ve got their paddle. The boat’s really built for one person, so another person can’t come in and paddle for you or tell you where to go, because it will sink the boat. And then if they leave their boat and abandon their paddle, that’s not great for them either. So we can have people beside us supporting us, holding onto their own paddle and living their own life, staying in their own boat, and smiling on the side and giving us encouragement, but they can’t jump out and it for us.
So what do we have to do? We have to go, OK, well, where am I going? Maybe I want to paddle myself to the island of feeling calm. Maybe I want to feel confident. Maybe I want to feel courageous, adventurous, relaxed, ease, abundant. We have to decide where we want to go, because we’re teaching our brain what neural pathways to fire.
So if I say I want to feel courageous, I’m telling my brain, “I want to fire the courageous neurons. I want to feel that thrill of achieving something and challenging myself.” So for me, that might mean I choose to go surfing, which equally terrifies me but also brings a sense of love and connection to the ocean and nature, and I feel courageous. So a therapist can’t tell me what to do, because they don’t know who I am and what I want to feel and how I achieve that.
Now, generally speaking, the way my clients come to me is they’re in their boat, they’re terrified, they’re holding onto their paddle, they don’t know what to do, they’re looking behind them, and all they see is symptoms. It’s anxious, it’s depression, it’s the dizziness, it’s the tinnitus, it’s the brain fog, it’s the headache and migraine, the pressure in the head. And they’re just paddling as fast as they can to get away from it. They have no idea where they’re going. They are exhausting themselves paddling in any direction so long as it’s not in the direction of what they don’t want to feel. So they’re 100 percent clear on what they don’t want to feel. They have no idea what they actually want to feel.
And so in the therapy for neuroplasticity, we reverse the equation. Rather than reinforcing the neural patterns that we don’t want to feel so our life becomes this exhausting race to get away from what we feel is going to hurt us and think we don’t like, we shift it into, OK, that’s behind us, and it doesn’t matter. It can be there.
What we’re going to do is to focus on really effectively moving towards what we want to feel. Let’s say it’s the island of calm. We want to release calm neural pathways. We want to feel confident. We focus on that. We choose to do things that we know work for us. We know that if I listen to this music or if I do this body scan or if I write a letter to my best friend, I’m going to release calm neural patterns. We hold onto our paddle, and we make those choices, and we really effectively move in that direction of what we want to feel. And what do you know? People go, “Joey, I feel calm.”
So as we reverse that neural patterning, we can automate it. So instead of automating the anxiety — and most of my clients have a PhD in feeling anxious and freaked out about their sensations and symptoms and running away from them. They’ve nailed that. They’ve done that on repeat probably for years. And so they don’t need to practice that anymore. And if there’s a real true threat, they know what to do.
So we teach the brain to now worry about things that aren’t real, as in imagined anxieties. Allow your fight, flight, freeze system to work strong, fast, and powerfully when there’s an actual threat, like a bush fire or hurricane, whatever. Then you want to have that system working. But in every other part of your life, you want to be focused on what you want to feel, and you want to automate that calm feeling. You want to do it so much and feel it so often that you don’t even think about it anymore. That becomes your new normal.
That’s what neuroplasticity’s about. It’s about repeating — identifying what you want feel — that’s a big one — then figuring out how you actually authentically fire that feeling for yourself and generate that stimulation of neural synaptic connections and pathways, and then do it as often as you can. Be really gentle as you support yourself to make that pathway more robust, automate it so it becomes your new normal.
It doesn’t feel like it’s a very vestibular-specific therapy. It can’t be. And people who are trying to get rid of their symptoms continue the neural loop. Think about the person with the paddle exhausting themselves trying to get away from symptoms. It doesn’t matter what your strategy is. You might use a device, you might use medication, you might use physical therapy, you might use diet. If your purpose and intention is to get rid of the migraine, you are reinforcing the importance of the migraine and telling the brain it’s important to you, right? Your brain doesn’t speak English. So if you put money into getting rid of your migraine, you’re actually telling your brain, “This is so important to me, I want more of it.” This is the clincher.
So what we have to do is to teach the brain, You know what? I think the migraine might be telling me that I’m a little bit stressed or overworked. In that regard, it’s important to me, but it’s not important that we keep reminding that signal every day. I get it. I’ve heard it, OK?
So now, brain, what I want you to focus on is feeling confident, is feeling at ease, is feeling a sense of peace in myself. And you and me, brain, we’re going to focus on those, and we’re going to figure out how to fire up those neural patterns. We’re going to learn where they are. We’re going to learn how to stimulate them. This is our focus. So if I spend money and if I go get therapy, it’s on feeling at peace. It’s not on getting rid of my migraine, because that reinstigates that old pattern that we don’t want to put the volume up on anymore.
So we acknowledge that the migraine or vestibular patters are there, the dizziness, the distortions. We acknowledge them. We’re not denying them. We’re not distracting them. We’re not avoiding them. We’re acknowledging they’re there, and then we’re saying, What do I actually want to feel? How can I soothe this, acknowledge it, but not get bogged down in it and obsessed with it and focused hypervigilantly on it? How can I then say, OK, something in my biology is out of balance?
Mentally, emotionally, and spiritually, I have quite a lot of control there in that invisible world. The doctors can’t do a thing there, but I’m in control there. How can I focus on what I want to feel and change the ratio and the allocation of resource in my brain to be focused on what I want to feel and to be the person I want to be instead of teaching my brain to focus on being the person I don’t want to be and to feel the things I don’t want to feel?
And that’s why it becomes a whole-person therapy, and it’s really exciting to see people heal, because everybody does it so differently. It’s not a prescription. It’s not cookie cutter. So I think it’s important that people don’t get stuck in this thing of, “Oh, well, I’ve got a vestibular injury, and I’ve got vestibular migraine, so I’m stuck with it forever.” That’s not the full story. Yeah, you might have it for a year or two, but you can grow out of it. You can adapt. You can completely change your brain.
Yes, it can come back again, but if you’ve got the skills and tools to recover and heal it, who cares? Look, I’m not afraid of it anymore. If it comes back, I’ll manage it. I’ll work through it. I’ll heal it again.
Molly: It really is fascinating, the whole process, and I hope for people watching or listening at home that something along the way that we’ve talked about within this interview really resonates, because you provided great analogies, and I’m coming up with my own as well — “Oh, like this.” So really good to hear.
I think we’ll be wrapping up here on Spotlight on Migraine. I’d like to say a big thank you so much to Joey Remenyi for joining us today from Australia, dealing with the time difference. Thanks so much for being here.
Joey: It’s a pleasure, and please visit my website if you want to learn more. I’ve got so many resources, and you can find that at SeekingBalance.com.au.
Molly: It’s been a pleasure to have you and very insightful.
If you do want more information, you can go ahead and visit Joey at her website or visit her YouTube channel at Seeking Balance International. And don’t forget to check out her new book. It’s called Rock Steady: Healing Vertigo or Tinnitus with Neuroplasticity.
Thank you so much for watching Spotlight on Migraine. I’m your host, Molly O’Brien. If you want any more information on vestibular or other types of headache disorders, visit us at MigraineDisorders.org. Until next time, I’m Molly O’Brien.
*The contents of this podcast are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The speaker does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.