RESOLUTION OF VESTIBULAR MIGRAINE COMPLICATED BY AUTOIMMUNE HYPOTHYROID WITH A PROGRAM OF MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION
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1
Independent researcher, United States
Background: A 51 year old female presented to a private clinic with a history of chronic dizziness that had been getting progressively worse over the last several months. She had been given a diagnosis of vestibular migraine by an Ear, Nose and Throat specialist. She had numerous episodes of Benign Paroxysmal Positional Vertigo (BPPV) previously in her history which were resolved with Epley's maneuver. She has a history of gastrointestinal symptoms that were diagnosed as Irritable Bowel Syndrome (IBS) and hypothyroid that was diagnosed as Hashimoto's. The patient describes the dizziness symptoms as her head is "a balloon floating above my body." Her autoimmune hypothyroid was being managed with medications by her endocrinologist.
Methods: Neurological examination revealed paradoxical findings on multi position blood pressure with a rise in blood pressure when the patient changed from seated to supine. Convergence insufficiency was observed on the right during eye movement analysis. Optokinetic eye movements were insufficient leftward and upward. Alternating hand movements revealed dysdiadochokinesia (DDK) on the left. Saccodometry of 100 saccades revealed hypometria with leftward and rightward saccades. Computerized Dynamic Posturography (CDP) revealed an anterior center of pressure (aCOP) on perturbed surface testing. CDP testing with head in right rotation revealed an abnormal loss in stability. CDP testing with head in extension on a perturbed surface revealed a near fall. Palpation revealed several areas of aberrant spinal segmental movement in the cervical and thoracic spine. A program of multimodal neurorehabilitation included vestibular rehabilitation (VR), spinal manipulative therapy (SMT) and Low Level Laser Therapy (LLLT). VR included gaze stability exercises, passive and active vestibular canal stimulation, laser guided visual feedback and eye movement exercises.
Results: Saccodometry revealed resolution of the hypometria. CDP revealed an improvement in stability with head to the right and in extension. There was a resolution of aCOP on perturbed surfaces. Convergence test normalized. OPK testing normalized. Patient reported a resolution of dizziness symptoms that now only rarely occur with extreme fatigue.
Conclusion: this author recommends further investigation into multimodal neurorehabilitation protocols that include VR, LLLT and SMT for the treatment of chronic dizziness and vestibular migraine
Keywords:
Dizziness,
dizziness and vertigo,
vestibular migraine,
Vertigo,
Hashimoto's,
autoimmune disease,
Hypothyroid,
IBS – Irritable bowel syndrome,
Neck Pain,
Shoulder Pain,
Spinal manipulative therapy,
Low level laser therapy ( LLLT),
Vestibular Rehabilitation,
Clinical Nutrition,
Center of Pressure (COP),
saccodometry,
convergence insufficiency,
Benign paroxysmal positional vertigo (BPPV),
Migraine,
dysautonomia,
orthostatic blood pressure
Conference:
International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.
Presentation Type:
Poster Presentation
Topic:
Clinical Neuroscience
Citation:
Schiller
D
(2019). RESOLUTION OF VESTIBULAR MIGRAINE COMPLICATED BY AUTOIMMUNE HYPOTHYROID WITH A PROGRAM OF MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience.
doi: 10.3389/conf.fneur.2019.62.00015
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Received:
02 Apr 2019;
Published Online:
27 Sep 2019.
*
Correspondence:
Dr. David Schiller, Independent researcher, Avon, United States, drschiller@comcast.net