Vestibular Migraine with Iyad Salloum

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum, he's the clinical director of Insync Physio in North Burnaby. And we're gonna talk about vestibular migraines. Wow, big words. What does this mean Iyad? 

Iyad: Yeah. Hi Mark. First of all, thanks for doing this. Yeah, so we've been seeing quite a few of these more recently. A lot of them don't know that those headaches are migraines because I think the word migraine's so commonly used, you know, people say, oh, I had a headache, but it's not a migraine. Oh, I have a headache and it's a migraine. A migraine isn't necessarily just a severe headache, but it also has to follow certain kind of criteria.

So usually in those cases, people suffer from, you know, diagnosable migraines, and then those migraines seem to have an additional kind of cluster of symptoms, which involve a bit of dizziness, a bit of vertigo. And you know, identifying those things is probably the first most important step. And we see a lot of people kind struggle with that.

Before the migraines, you know, from our physician colleagues, we tend to create a program that helps address any of the vestibular impairments that have created from the migraine. 

Mark: So I guess the obvious thing would be you've got a headache. The symptoms would be you've got a headache, but you are feeling vertigo. What's the difference between dizzy and vertigo?

Iyad: That's a great question. So dizziness is just the general term that we used to describe any feeling of being unsteady, being uneasy, like you know, people will have different descriptions for that. So they'll say, oh, I feel lightheaded sometimes.

And then some people will say, I feel like the room is spinning. That room is spinning phenomenon, that's vertigo. Because it's the illusion of movement in the environment when we are not moving. And then we have different types of dizziness too, where people say, I feel like I'm floating on a boat, that's another kind of complaint. Like you're riding a wave. Those kind of things where you feel a bit of unsteadiness when you move. All of those things could be called dizziness, but vertigo is specifically when we have that perception of things spinning or that the room is moving when you're not. 

Mark: So I imagine this is pretty upsetting for people to have the amount of pain that they're possibly having with the migraine and then the bloody room is spinning. Yeah. So what's what kind of causes, what are the possible causes? 

Iyad: We actually don't know what causes migraines. We know it'll affect certain people more than others. Women seem to be more susceptible to this. But we actually have, and there's been a few kind of theories about it, but there's no real kind of magic bullet that we could say, oh, this is what causes this. However, you know, whenever I see somebody in clinic and they've been complaining about spinning or dizziness or vertigo or whatever, one of the first questions we ask is to rule out headaches. And the reason we wanna figure out headaches is well, there's also the neck.

The neck can cause headaches sometimes. You can get something called the cervicogenic headache. But the neck can also be a source of dizziness where we have a bit of this, let's call it a mismatch with our senses, where let's say your vision tells you one thing, your inner ear tells you one thing and then your neck telling you something else.

So that kind of loss of position sense could cause that too. So that's why we wanna figure out what kind of headache they are now. Lucky for us, the neck headaches, most of us physiotherapists, even the ones who don't treat vertigo are quite adept at treating and assessing for neck related impairments that cause the headaches. But we tend to go a little step further into vestibular work, where we try to figure out what kind of headache it is. And if it is, let's say a migraine or if we're suspecting a migraine, we will pass them on to our physician colleagues, get them the help they need. And then we would treat the resultant after effects of that migraine. 

And I think it's really gonna worth noting that this is the thing that I see equally, over and under diagnosed, if there is such a thing. Again, a lot of people who say they have migraines when it could be a tension type headache or a cervicogenic headache where we treat their neck and they never have a headache again. And again, a lot of people who think it's tension and think it's stress, but it's actually just a migraine.

And so we would wanna kind of take our time and actually get a good idea of what type of headache we have. And we have certain criteria that help us kind of give clues as to is it this thing or this thing. The good news is, some people with just the treatment of the migraine completely lose their vestibular symptoms, which are the unsteadiness, the dizziness, the vertigo potentially.

And that's a good sign. So we try to really get those let's say differentiated, what type of headache we're dealing with and then try to get them the proper help, because it is very treatable. 

Mark: So what is the treatment? What do you do? 

Iyad: So our physician colleagues will prescribe the adequate medication for that. And that seems to be quite effective. At least the people that we've worked for in the clinic seem to respond quite well to that. Usually afterwards lets say we will assess things like, are they able to maintain their gait stability? We will assess for if they have certain movements that they're sensitive to, and then we give them a program to address those impairments.

There's really no one impairment or two impairment thing that you kind of say that, oh, people with vestibular migraines get. But they do get vestibular impairments that look a lot like some of the other things that we've talked about in the past, like inability to focus on an object while they move, sensations of the room spinning with the head turning so quick, you know, things like that.

And we try to just rule out what are we dealing with here? And then the most important thing is giving a program that's specific to the impairment that we see. Because the impairments are so wide, it's just really important for us to figure out what's the biggest contributor. Because some people just need to work on their balance and postural control and they get better.

And some people need to do more retraining of the reflexes, like the vestibulo ocular reflex, and a few other things that we would prescribe exercises for, to help figure out their impairments there, like if they have a gait stability issue, for example. 

Mark: So this does not sound like a candidate for Dr. Google to figure out what's going on. 

Iyad: It could be a good way to kind of figure out if you should talk to someone about having a migraine potentially and getting the help you need. But it's kind of hard for you to diagnose your own gait stability issues. I mean, it's really hard for you to see your eyes when you're trying to move your head side to side. So it is hard for you to self-diagnose. And it's way easier for somebody just to have a quick look at it, assess you and move on instead of trying to throw random treatments at the wall and see what sticks.

For the most part, if somebody has a migraine spectrum, they can't get medication unless they get a prescription for certain things. So it's not like you can just go to the pharmacy, just try random things. But yeah, I would just strongly encourage people who have this, to just get a workup and see, are you actually dealing with migraines or is this another type of headache? And if it is another type of headache, is this something that could respond to just regular treatment of manual therapy exercise and advice. 

Mark: So if you want expert help, if you're feeling dizzy, if the room is spinning, if you've got headaches along with it, the guys to see are Insync Physio in North Burnaby. You can reach them at their website, or you can call and book (604) 298-4878. They also have an office in Cambie (604) 566-9716. Thanks, Iyad. 

Iyad: Thank you.