Georgia Chiropractic Neurology Center

Brain Based Treatment for the 21st Century!

Written by Sophie Hose, DC, MS, CCSP

Vestibular migraines (VM) are a perplexing and often debilitating condition that sits at the crossroads of neurology and otology. They are characterized by the convergence of migraine headaches and vestibular symptoms, such as vertigo, dizziness, and imbalance, which can significantly impair daily functioning. While the precise cause of vestibular migraines remains under investigation, there is a growing recognition of the condition’s neurological underpinnings and its response to chiropractic neurology interventions. This blog post will explore the nature of vestibular migraines, their underlying mechanisms, and how chiropractic neurology offers a holistic and effective approach to managing this condition.

Understanding Vestibular Migraines: A Neurological Perspective

Vestibular migraines are more than just migraines accompanied by dizziness; they represent a complex interaction between the brain’s pain-processing pathways and the vestibular system (located in our inner ears), which governs balance and spatial orientation. The condition often manifests with vertigo, unsteadiness, and motion sensitivity, sometimes even in the absence of headache. This complexity makes diagnosis and treatment challenging.

The pathophysiology of vestibular migraines is deeply rooted in the brain’s neurochemical and structural environment. One key element is cortical spreading depression (CSD), a wave of neuronal and glial depolarization that moves across the cortex and is believed to underlie the migraine aura, a range of visual and other sensory disturbances that usually precede a migraine. CSD can trigger the release of neuropeptides that activate the trigeminal nerve, leading to the sensation of pain. The trigeminal nerve is one of our 12 cranial nerves and it is responsible, amongst other functions, to relay painful sensation from the face. In vestibular migraines, this process is thought to extend to brain regions involved in processing vestibular information, such as the brainstem and cerebellum. Dysfunctions in these areas can lead to the abnormal processing of sensory inputs, resulting in the dizziness and vertigo characteristic of vestibular migraines.

The Chiropractic Neurology Approach to Vestibular Migraines

Chiropractic neurology, a discipline that integrates chiropractic care with a deep understanding of the nervous system, offers a unique approach to managing vestibular migraines. This approach goes beyond the traditional chiropractic focus on spinal alignment to include the assessment and treatment of the entire nervous system, particularly the brain and its interaction with the body’s structural components.

  1. Spinal Alignment and Neurological Function: Chiropractic neurologists often begin by examining the cervical spine (neck) for misalignments or dysfunctions. The cervical spine especially has a tremendously important relationship with the brainstem and particularly the vestibular nuclei that live in the brainstem, responsible for integrating information from the vestibular system. Receptors in the spine that detect motion of the bones, joints, muscles, ligaments and tendons that make up the spine, called spinal proprioceptors, relay information about where our spine is in space to the brain, including the areas that integrate vestibular information. Our brains interpret the information it gets from the vestibular system and from the spine and initiates appropriate postural responses and movements. For example, if a patient perceives their center of pressure to be further behind than where it normally is or should be, their subconscious response will be to lean forward. This close relationship between the spine and the vestibular system explains why patients will often experience a relief of symptoms and an improvement in their condition when their doctor work on their spine, whether it be through chiropractic adjustments or through targeted myofascial work on the fascia of their neck. This is crucial for reducing both the frequency and intensity of vestibular migraines.
  2. Vestibular Rehabilitation: Beyond spinal adjustments, chiropractic neurologists employ vestibular rehabilitation exercises designed to retrain the brain to process vestibular information more effectively. These exercises typically involve gaze stabilization, balance training, and head and eye movement exercises that challenge and enhance the brain’s ability to integrate sensory input from the vestibular system. This can lead to a reduction in dizziness and an improvement in overall balance, which are key goals in managing vestibular migraines.
  3. Proprioceptive Training: Proprioception, the body’s ability to sense its position in space, is often impaired in individuals with vestibular migraines. Chiropractic neurologists use specific exercises to enhance proprioceptive input, which can help recalibrate the brain’s processing of spatial information. This training often involves tasks that require the patient to identify different sensory stimuli on their body, such as discriminating between light and deep touch or between sharp and dull stimuli, as well as recognizing shapes or letters drawn onto their skin and localizing where on their body they are being touched. Further therapy may include coordination and balance, such as standing on one leg with eyes closed or using unstable surfaces like balance boards. By improving proprioceptive input, these exercises can help mitigate the disorientation that often accompanies vestibular migraines.
  4. Comprehensive Neurological Evaluation: One of the hallmarks of chiropractic neurology is its emphasis on a comprehensive evaluation of the nervous system. For patients with vestibular migraines, this evaluation includes assessing the function of the vestibular system, the proprioceptive system, the visual system, the autonomic nervous system, and the brain’s oxygenation levels. By identifying dysfunctions in these areas, chiropractic neurologists can tailor their treatment approach to address the specific neurological deficits contributing to the patient’s symptoms. This individualized care is critical in managing a condition as complex as vestibular migraines.

Lifestyle and Holistic Interventions

Chiropractic neurology also emphasizes the importance of lifestyle modifications and holistic care in managing vestibular migraines. While neurological and structural interventions are central to treatment, they are most effective when combined with strategies that address potential triggers and promote overall health.

  1. Stress Management: Stress is a well-known trigger for migraines, including vestibular migraines. Chiropractic neurologists often work with patients to develop stress management techniques, such as mindfulness, relaxation exercises, and cognitive-behavioral strategies. These techniques can help reduce the frequency and severity of migraine attacks by lowering the overall stress burden on the nervous system.
  2. Sleep Hygiene: Adequate and quality sleep is essential for neurological health. Poor sleep can exacerbate migraine symptoms by disrupting the brain’s ability to regulate pain and sensory processing. Chiropractic neurologists may offer guidance on sleep hygiene practices, such as maintaining a regular sleep schedule, creating a sleep-conducive environment, and avoiding stimulants before bedtime. Improving sleep quality can have a significant impact on reducing the incidence of vestibular migraines.
  3. Nutritional Support: Certain nutrients have been shown to support neurological function and may help in managing vestibular migraines. For example, magnesium and riboflavin (vitamin B2) are commonly recommended for their role in reducing migraine frequency. Chiropractic neurologists might also advise on dietary changes to avoid common migraine triggers, such as gluten, dairy, caffeine, alcohol, and certain food additives. A balanced diet that supports brain health can be a valuable component of a comprehensive treatment plan.

Case Studies and Success Stories

The effectiveness of chiropractic neurology in managing vestibular migraines is supported by numerous patient success stories and case studies. For instance, patients who have struggled with chronic vertigo and dizziness, often unresponsive to conventional treatments, have found significant relief through chiropractic neurology care. These patients report improvements in balance, reductions in migraine frequency, and an overall enhancement in quality of life.

In one notable case, a patient with a long history of vestibular migraines and associated anxiety found relief through a combination of cervical spinal adjustments, vestibular exercises, and lifestyle changes. Over several months of consistent care, the patient experienced a marked decrease in migraine episodes and a restoration of normal daily functioning. This case highlights the potential for chiropractic neurology to offer a holistic and effective treatment pathway for individuals suffering from vestibular migraines. At the same time, this case shows that treatment for vestibular migraines is a lengthy process that is not completed within just a handful of visits. In order for the patient to have the greatest success, it will take several weeks or even months for the changes that are made in therapy to be fully plasticized and a full recovery cannot be guaranteed without a detailed and personalized examination by a licensed health care provider.

Vestibular migraines are a complex condition that requires a multifaceted approach to treatment. Chiropractic neurology provides a unique and effective framework for addressing the neurological, structural, and lifestyle factors that contribute to this condition. Through myofascial work, vestibular rehabilitation, proprioceptive training, and comprehensive neurological evaluation, chiropractic neurologists help patients manage their symptoms and improve their quality of life. By integrating these techniques with holistic care practices, such as stress management, sleep hygiene, and nutritional support, chiropractic neurology offers a well-rounded approach to managing vestibular migraines, paving the way for lasting relief and enhanced well-being.

If you or someone you love is suffering from vestibular migraines and you would like to learn how chiropractic neurology can help, contact the team at Georgia Chiropractic Neurology Center today. We look forward to hearing from you.

References

  1. Chen Z, Xiao L, Liu H, Zhang Q, Wang Q, et al. “Altered thalamo-cortical functional connectivity in patients with vestibular migraine: a resting-state fMRI study.” Neuroradiology. 2022;64(1):119-27.
  2. Versino M, Mandala M, Colnaghi S, Ricci G, Faralli M, et al. “The integration of multisensory motion stimuli is impaired in vestibular migraine patients.” J Neurol. 2020;267(10):2842-50.
  3. “Vestibular Migraine Pathophysiology and Treatment: a Narrative Review.” Current Pain and Headache Reports. 2023.