While of course I am a huge supporter of Physical Therapy (PT) for chronic vestibular and concussion disorders, I also realize that PT is just a piece of the puzzle to help our clients improve their function and symptom management.  Oftentimes, chronic vestibular and concussion dysfunctions require a multifaceted team approach to achieve the best outcomes.  Other interventions to consider when living with a chronic vestibular or concussion condition should include:

1. SLEEP HYGEINE

Establishing a bedtime routine and maintaining a consistent sleep schedule, no matter what events are happening in life, is one of the most effective ways to help manage chronic dizziness, brain fog, energy depletion, and other symptoms associated with chronic vestibular and concussion disorders. Good sleep hygiene includes: limiting time on screens prior to bedtime, maintaining a comfortable temperature in your bedroom, limiting ambient light and noise, and watching what you eat or drink before bed (like being sure to not have alcohol/caffeine).

2. NUTRITION

Chronic vestibular disorders and prolonged concussion symptoms both respond positively to an anti-inflammatory diet.  What exactly does that mean?  Eating foods styled similarly to the Mediterranean diet constitute an anti-inflammatory diet.  These foods help reduce inflammation in the brain and vestibular system that can prolong or worsen symptoms.  Foods including vegetables, chicken and fish, and healthy fats and oils are all beneficial.  Working with a nutritionist can provide you with invaluable tools to help manage symptoms through your diet.  In some conditions, such as vestibular migraine, foods can contribute to pushing you over the symptom threshold and trigger a migraine.  Watching food is one way to manage that threshold and your symptoms!

3. COMORBIDITIES

Comorbidities are other health conditions that you may have at the same time as your chronic vestibular disorder or post-concussion syndrome, such as high blood pressure, eye disease, neuropathy, anxiety, or neck pain (as examples).  Improper management of comorbidities can contribute to and cause symptoms that are also associated with vestibular and post-concussive disorders such as dizziness, brain fog, fatigue, and imbalance.  Maintaining the health of all of your body’s systems can help reduce the overlapping symptoms that can make a vestibular or post-concussive disorder feel worse.  Addressing these other health items can also help break a “negative loop cycle”, in which the symptoms of one problem (such as high anxiety levels) increase the symptoms of another problem (like dizziness from a vestibular disorder).  

4. SUPPLEMENTS

Along with proper nutrition, there is research to support the use of nutritional supplements to help maintain brain and vestibular wellness to reduce inflammatory processes that can contribute to disorders.  The supplements that are most often prescribed for chronic vestibular disorders and concussion include Magnesium, Riboflavin, and Co-Q10.  Newer research also suggests that Vitamin D may be beneficial in helping reduce recurrence of BPPV in individuals where that seems to be a more frequent problem.  Because of potential interactions between supplements, prescription medications, and their effects on other systems of the body, you should discuss them first with your doctor and potentially a nutritionist to determine the dosages that are best for you.

5. MENTAL HEALTH

Any chronic health conditions comes with a mental health component, as you learn to adapt your lifestyle because of your illness or dysfunction.  Events and tasks that previously were easy, such as work, going out with friends, or even driving the car, may now present challenges that require more energy and management strategies.  It is perfectly normal to feel a whole range of emotions along with that including sadness, depression, and even anger.  And because of the effect of concussion and connection of the vestibular system to our autonomic nervous system, anxiety can also increase.  Similarly to the negative loop cycle that we talked about earlier, we can develop a dizzy-anxious-dizzy cycle.  In this cycle, the sensation of dizziness that you experience can make you feel anxious.  In turn, that increased anxiety can actually make you feel more dizzy.  And the cycle continues.  Addressing mental health is a key component to addressing any chronic health condition.

Again, treating post-concussion syndrome and chronic vestibular conditions often requires a whole team.  Begin with your current providers and seek recommendations to help build a team specific to your needs.  This process can take time and requires patience, but it will be worth it for your health long term.