Meniere's disease, vestibular migraine and lifestyle - what you should know

Disclaimer: During our Dizziness Can Be Stubborn webinar, many inquirers asked for specific treatment recommendations for their particular scenario. Please be advised that as per our College regulations, I am not permitted to provide treatment advice for an individual’s symptoms without performing an assessment. Hopefully my more general responses will help answer your questions, but the best approach is to discuss your particular symptoms with your Doctor and Vestibular Therapist.

Can my lifestyle affect my dizziness?

Q: Can dizziness be a result of allergies/barometric pressure change too? 

A: While not one of the more common ones, dizziness is one of the symptoms that allergy sufferers may experience. Research has suggested a potential relationship between allergies and Meniere’s Disease – not ‘cause and effect’ but just that allergic conditions are more common in those with Meniere’s than those without. Similarly, barometric pressure changes may have a relationship with Meniere’s attacks in some people, and particularly migraine attacks.              

Q: Is there any research that screen time (computers and smart phones) contributes to vestibular decompensation?

A: Interesting question. Screen time (whether it be phones, computers, TV, movie theaters) can certainly stir up symptoms for those with vestibular problems who have visual motion sensitivities.  As far as decompensation goes though, I’m not aware of any research that has looked at that specifically. I would say that if someone had compensated well for a vestibular issue then suddenly started a lot of screen time that they hadn’t been doing since their vestibular insult (so the brain hadn’t been exposed to this along the way), then they might decompensate.

Q: Sheelah just mentioned diet. How does diet affect the vestibular system?

A: There are certain vestibular conditions that may be affected by diet. With Meniere’s disease, people are often coached to maintain even fluid levels to the best of their ability. It’s important to keep hydrated and maintain caution with salt, caffeine, sugar, and alcohol consumption. Similarly, vestibular migraine may well have a dietary trigger for people - so they would want to make an intake diary to see if they can figure out if there’s a pattern. Learn more about migraine triggers.

Q: What recommendations do you have for people with very intermittent vertigo with regard to driving?

As vestibular therapists, it is not our jurisdiction to tell people whether they should be driving or not. If your intermittent vertigo has been confirmed to be from BPPV only, then you would want to avoid rapid head movements, looking up (say, at the controls for your sunroof), or down (say, if you dropped something) if the BPPV is active. That should really be a discussion you have with your Doctor or ENT Specialist if you have one.

What impact does Meniere's disease have on dizziness?

Q: How can Meniere's disease be diagnosed or be determined to be the cause of dizziness?         

A: We would want a very detailed, step-by-step description of your spells to see if the symptoms and pattern fit this diagnosis or not. Many vestibular disorders have diagnostic criteria that have been developed to help guide us. We look for characteristics such as vertigo that comes in episodes lasting 20 minutes to 12 hours (or more remotely, 24 hours). Additionally, we would expect reports of fluctuating hearing, tinnitus and/or a sense of ear fullness, often with a certain pattern of hearing loss on the one side.   

Q: For Meniere's disease, will surgery be an option for the vertigo to go away?

A: For those with severe, frequent attacks, who haven’t been helped by more conservative measures, surgery may be considered as a last-resort.

Vestibular migraine - what you should know

Q: Will you have severe headaches if you have vestibular migraine? What are the signs?

A: You may, but the interesting thing about vestibular migraine is that you don’t necessarily need to have a headache at all. That’s why it gets frequently missed as a possible diagnosis. Please read the blog I wrote about the signs and symptoms of vestibular migraine.

Q: Vestibular migraine - does that imply restricted or enhanced blood flow to the inner ear?

A: The thought is that the neurovascular changes could involve the arteries to the inner ear, but more likely to the vestibular processing centres in the brain.

Q: I have had a couple of episodes of scintillating scotoma and ocular migraine. My optometrist said it was from the brain and not optical so just wondering if BPPV and 3PD would be brought on by the same type of issue?

A: Scintillating scotomas (or temporary patches of missing or distorted/flickery areas in your vision) are a common migraine symptom, and yes, that comes from the brain, not the eyes. Just like ocular migraine can give you these visual symptoms, vestibular migraine can give vestibular symptoms of dizziness &/or disequilibrium. Vestibular migraine sufferers do not necessarily have these sorts of visual disturbances, but if they do, it really helps to point to this as a probable diagnosis. Other conditions like BPPV or 3PD would not have scintillating scotoma or a direct migrainous cause.

Q: I have quite bad photophobia and vision issues, how does this play a role? I have been diagnosed with vestibular migraine but I worry it's more.

A: As you’ll see from the other questions in this section, photophobia and vision issues can definitely come from vestibular migraine. I don’t know the details of your other vision issues, but particularly if you feel they’re there even between spells, you should check in with your optometrist at a minimum. You could also discuss a referral to an ophthalmologist or neuro-ophthalmologist with your Doctor to see if they think that might be in order.

Q: Is chronic sinusitis and/or migraines linked to dizziness/vertigo?

A: You wouldn’t necessarily have dizziness/vertigo with these things, but you could if in addition to the sinus infection you also have an inner ear infection, or if your migraine happens to affect the vestibular processing.

Q: With chronic vestibular migraines, is it normal to feel its effects 24/7 with varying severity?

A: The diagnostic criteria for vestibular migraine (including probable) cite that spells can last anywhere from 5 and 72 hours, so “24/7” sounds unlikely unless you’re referring to the general sensitivity to light and visual stimulation that people dealing with migraines tend to have even between spells.

Q: How do you diagnose vestibular migraine?

A: The blog mentioned above has the characteristics we look for. There are also more technical diagnostic criteria available in this journal.

Q: Vestibular Migraine sufferer here. It’s a constant challenge trying to continue pushing my vestibular system without triggering a major attack, then also not going too far and guarding movements to limit symptoms - what are some tricks for finding the balance or the sweet spot?

A: I don’t really have any ‘tricks’ I’m afraid! You’re right, it is all about finding the sweet spot, which often means stopping even though you think you can handle a bit more just to make sure you don’t get a spell, and if not, doing a little more next time.  Also, migraines often need the right combination of triggers to build up, so if the deck is stacked against you due to your dietary choices, a poor sleep, a bit of weather change, etc. then a spell may be triggered more easily. 

Make sure you’re focusing on all the elements of migraine management, not just vestibular exercises designed to reduce residual symptoms between spells.

To learn more about vestibular rehabilitation, check out our services page. If you’re interested in booking an assessment with a vestibular therapist, you can do so online or find a clinic near you.