Northern Speech Services, National Rehabilitation Services

OBJECTIVES: The purpose of this study was to assess the efficacy of physical therapy for patients with vestibular disorders with and without a history of migraine headaches. STUDY DESIGN: Retrospective case series. SETTING: Outpatient physical therapy clinic. PATIENTS: Thirty patients with both a history of migraine and a diagnosis of vestibular/balance disorder considered unrelated to migraine were identified by retrospective chart review. Thirty patients without a history of migraine, matched retrospectively by diagnosis, vestibular function, and age (+/-5 years), were used as a comparison group. INTERVENTIONS: Both groups were treated with a custom-designed physical therapy program for a mean of 4.1 visits over a mean of 3.3 months. MAIN OUTCOME MEASURES: Patients completed the Dizziness Handicap Inventory, the Activities-Specific Balance Confidence Scale, the Dynamic Gait Index, and the Timed Up & Go Test and rated the severity of their dizziness on an analog scale of 0 to 100. RESULTS: Significant differences were demonstrated within both groups between initial evaluation and discharge in each of the assessment measures used. Patients with a history of migraine demonstrated worse scores on all outcome measures than did the patients without a history of migraine. There were no statistically significant differences between the two groups' scores before and after therapy except for the total Dizziness Handicap Inventory score at discharge (p < 0.05). CONCLUSIONS: Patients with vestibular disorders with or without a history of migraine demonstrated improvements in both subjective and objective measures of balance after physical therapy. Patients with a history of migraine perceived a greater handicap from dizziness than did patients without a history of migraine that was greater than the difference in physical function performance measures between groups.