HealthNotes

People with MD are frequently found to have musculoskeletal disorders of the head and neck,⁴ including cervical spine disorders (CSD; disorders of the joints of the neck),⁵ and disorders of the jaw (craniomandibular disorders or CMD).⁶ Physical therapy to the cervical spine relieves MD-like symptoms in some cases, according to one preliminary report.⁷ Although spinal manipulation has been shown to reduce vertigo in preliminary human studies,^{8, 9, 10} controlled research with MD patients is lacking.

Some authorities recommend psychological counseling¹¹ to reduce both the significant emotional distress caused by living with this disorder^{12, 13} and possible stress-related MD symptoms,^{14, 15} however, the benefits of counseling have not been established by controlled research. MD is not caused by psychological factors,¹⁶ and it is unclear whether stress increases the frequency or severity of attacks.¹⁷ Preliminary human studies suggest that stress increases awareness of symptoms,¹⁸ particularly vertigo.¹⁹ In a controlled human study of tinnitus, which included three participants with MD, weekly one-hour sessions of relaxation and coping techniques for ten weeks significantly reduced both tinnitus and tinnitus annoyance.²⁰ Since very few of these participants had MD, it is not clear whether these techniques would be helpful for people with MD.

Vestibular rehabilitation exercises, used primarily to aid in recovery from vertigo, are also recommended by some authorities for MD,²¹ although controlled research on these exercises for MD is lacking. According to these authorities, the exercises should be started only after symptoms have been stabilized with other treatments, and should not be done during active MD. A qualified musculoskeletal healthcare specialist should be consulted.

Transcutaneous electrical nerve stimulation (TENS), a form of physiotherapy used by musculoskeletal healthcare specialists, has been reported to reduce tinnitus in people with MD in preliminary studies.^{22, 23, 24} TENS is thought to improve tinnitus by increasing circulation to the inner ear.²⁵ In one large preliminary trial, participants with tinnitus due to various causes, including MD, received two 25- to 30-minute treatments to the ear per week for three to five weeks.²⁶ Sixty percent of people with MD reported significant improvement of tinnitus after this treatment, and many reported a decrease in pressure in the treated ear. A controlled trial comparing the effectiveness of TENS and applied relaxation (AR; the use of an audiotape to guide the participant through a series of muscle relaxation exercises) in MD found either treatment produced similar positive results,²⁷ but these could have been due to placebo effects. In this study, participants treated themselves with three 30-minute TENS treatments to the hand per day for two weeks, with one participant continuing treatment for three months.

Acupuncture is reported to reduce symptoms of MD in preliminary studies.^{28, 29} In one trial, vertigo was eliminated after one to three treatments in a group of 34 MD patients, and measurements of hearing also improved.³⁰ Controlled research is needed to confirm these results.