Physical Therapy Success?

Has anyone had success reducing headaches/vertigo with PT? Vestibular therapy has definitely helped with my balance and gait, but I feel like some of the pressure and angles during neck and back therapy make me feel worse. I am concerned about some of the pressure being so close to the base of my skull. I made it through therapy yesterday without vomiting and even drove afterward, but I am miserable today. I’m hoping for long term success, but I don’t want to continue the therapy if it will be detrimental. My neurologist is not a Chiari specialist. Any experiences out there?

Hi there

I did not have much luck with traditional vestibular therapists. I did get help from a therapist who looks at vestibular and balance issues from a neuro-development point of view which makes sense for Chiari folk. I do not have problems with my inner ear but have problems with how my brain is processing vestibular and balance information. A vestibular therapist with a lot of experience with concussion patients can be more understanding of slow improvements and high levels of sensitivity.

The “dizziness and Chiari” posting in the Newbie section is what I started out with and the exercises worked great. Maybe your current vestibular therapist has training in primitive reflexes but it sounds like not. Maybe they would be receptive to it (or maybe just slough it off as craziness!).

You are in a different category though as you have not had the surgery. Your brain continues to be stressed by mechanical forces at the site of the brain hernia with upper cervical movements like the dreaded extension. Improvements with physical therapy may be reduced to assisting the brain in processing information - graded motor imagery, midline work, or spinning. Traditional physical therapy tends not to be helpful at best and painful with no improvements at worst.

Earlier this year, I did 3 months of all the primitive reflexes relating to vestibular development and have now started challenging all those vestibular canals in three dimensions. The ‘yee’ and the ‘yaw’ have me totally confused on which is which!

I am not currently aware of anything that assists with the occiput Chiari head ache. Maybe your neurologist has a theory on why Chiari folk get those headaches which would assist in pinpointing a valid course of treatment. Until they know, there are only shots in the dark. Doctors often state migraines, vestibular migraines or other, as the reason why with little subjective history to support a migraine. Migraine medications then tend not to help much.

My theory on the occiput headaches is the brain herniation in the spinal canal causes blood vessels (in the canal) that supply the occipital dural to become ischemic and cause that vague yet painful headache in the back of the head. Ask your neurologist for me as I no longer see neurologists!

It sounds like you are seeking help for your condition so good luck with that.

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I really appreciate that feedback! What you said makes a lot of sense. May I ask how you are treating your condition without a neurologist?

Please know that I have already had the occipital decompression surgery a number of years ago. I have seen many neurologists both before and after. None have been knowledgeable about Chiari nor terribly helpful. Not everyone has this experience. Though it seems that other people have just liked their neurologist better than I have, not that the neurologist was terribly helpful!

In my experience, and in talking with others here and elsewhere, neurologists are equipped to deal with Chiari through 1)referrals to other healthcare professionals and to diagnostic/testing facilities or 2) with medications. At my stage of dealing with Chiari, I am past the stage of further testing. You probably are not, nor with seeing other people - both to rule in and out other conditions and to get a better picture of what systems are affected by Chiari.

Neurologists that I have seen did not have to resources to know who to send me for further treatment for my brain processes post-surgery. I had to find qualified people on my own.

Vision disturbances: Optometrist specializing in concussion was helpful as was a vision therapist in my own city. This was not effective before surgery as my vision continued to deteriorate under her care. She sent me off for further investigation.

Balance and dizziness: Physical therapist trained in the neuro-development aspect of vestibular processing. Primitive reflexes and vestibular orientation.

Head pain post-surgery: Physical therapist trained in graded motor imagery, neurodynamics, and mid-line rehabilitation. Motor imagery and mid-line may help pre-surgery or at least stave off altered brain processes that develop with chronic pain that does not make sense to the brain.

These are the highlights of what I have done without a neurologist. It would be lovely to have a doctor to organize my post-surgery Chiari-related care and point me into another direction when I am ready or another brain processing problem emerges. That is not my situation. Hopefully, armed with more knowledge than I had, you can better find the professionals necessary to assist in your journey.