How to Treat Vestibular Migraine, PPPD, and MdDS (Especially When You Feel Stuck)

In this episode of Talk Dizzy To Me, vestibular physical therapists Dr. Abbie Ross, PT, NCS and Dr. Dani Tolman, PT welcome back Dr. Shin Beh for a deeper conversation on the diagnosis and treatment of vestibular migraine, Persistent Postural-Perceptual Dizziness (PPPD), and Mal de Débarquement Syndrome (MdDS).These conditions can overlap, feel confusing, and leave patients feeling stuck in their recovery. Dr. Beh breaks down how he differentiates these diagnoses clinically, why vestibular migraine can precipitate PPPD symptoms, and how treatment plans need a whole-person approach.

Treatment plans may combine lifestyle optimization strategies, vestibular rehabilitation, medication or supplements, neuromodulation, stress management, and more... and should absolutely be individualized.

Whether you're living with chronic dizziness or treating patients with vestibular disorders, this episode offers a practical, compassionate look at why there is no one-size-fits-all approach to recovery.

Episode Resources:

www.vestibularmd.com

Dr. Beh's Books: www.vestibularmd.com/about-dr-beh/books

Hosted by:

🎤 Dr. Abbie Ross, PT, NCS

🎤 Dr. Danielle Tolman, PT

For episode recommendations or requests, email us at: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠info@balancingactrehab.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Join our online program and community, The Dizzy Reset™. ⁠⁠⁠Use code TALKDIZZYTOME for 40% off your first month!⁠⁠⁠

Connect with Us:

→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Book a free call with us⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Get free resources straight to your inbox⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Join our online program and community, The Dizzy Reset™⁠⁠⁠⁠⁠⁠⁠

→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Watch podcast episodes (and more) on YouTube ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow us on Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow us on TikTok⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow us on Facebook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Disclaimer⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Enjoying the podcast? Leave us a review!⁠⁠⁠

→ ⁠⁠⁠Avulux glasses, use code DIZZYRESET for $25 off⁠⁠⁠

This episode is for educational purposes only and is not a substitute for medical advice. Always consult a qualified healthcare provider for diagnosis and treatment. The views expressed by guests are their own and do not necessarily reflect those of the host(s).

Timestamps:
01:37 How vestibular migraine, PPPD, and MdDS are diagnosed
04:20 How these conditions overlap
06:29 Why patients can feel stuck in recovery
08:17 Vestibular migraine treatment approach
08:45 Lifestyle foundations for migraine management
10:07 Supplements for vestibular migraine
11:04 Medication and neuromodulation options
12:01 Addressing sleep apnea, neck pain, TMJ, iron, and hormones
14:44 How to layer treatment without the overwhelm
16:03 When supplements, rescue meds, or preventives may be appropriate
18:25 Medication sensitivity and starting low/slow
21:11 PPPD treatment approach
22:08 Vestibular therapy, movement, and visual desensitization
23:59 Medications and neuromodulation for PPPD
25:53 CBT and the dizzy-anxious cycle
26:45 Lab values, vitamin D, B vitamins, magnesium, and ferritin
32:31 Timolol eye drops for migraine rescue
33:53 MdDS treatment approach
34:22 Travel and MdDS
35:44 Therapy for MdDS
36:39 Defining progress beyond symptom reduction
39:05 Knowing when to use rescue medication
43:24 Why vestibular disorders affect more women
45:08 COVID, vestibular dysfunction, and fibromyalgia
48:30 Migraine-related ear symptoms and hearing changes
49:37 Vestibular migraine and vestibular test findings
51:02 Final advice for patients and clinicians