Travelling with migraine and a vestibular disorder (vestibular migraine) can feel very overwhelming at times. There is so much movement, sounds and more that our senses can feel a little overwhelmed. Yet many of us have to (or want to) travel, for work or pleasure.
These are my tips for travel with migraine, and especially in a city environment. I hope that they are helpful.
Busy cities
London is a busy city. Just like all cities are. While the quiet of the parks and gardens are never far away, the streets of London are filled with people hurriedly bustling around, seemingly always late to get wherever they are going.
Navigating London tends to mean travelling on a bus, train or tube. Maybe all three, depending upon your destination. It may also involve some walking along the busy streets, weaving in and out of men and women in business suits or shoppers ducking and diving into the nearest department stores. Nothing seems to stay still a city. Everything is on the move. Shifting up and down, side to side. Perpetual motion and perpetual noise. Sensory overload can easily happen to those of us with chronic illness conditions.
All in all, London is a rather tricky city to navigate with a vestibular disorder. There are many aspects of city life that can trouble our sensitive brains and induce or heighten the dizziness, vertigo and balance issues we have to contend with. Walking down the street can feel like walking on a floaty cloud at the best of times with a vestibular disorder, so factor in people walking at speed past you, the noise, bright lights, traffic etc etc and it can all become very overwhelming very quickly.
Short of moving to the countryside, there isn’t much I can do to avoid being in central London on quite a frequent basis. Aside from anything else, the vast majority of my medical appointments are there and so travelling into the hustle and bustle is something I do at least once a week, often more, whether my vestibular disorder likes it or not.
When I was first experiencing my symptoms of vestibular migraine I flat-out avoided central London unless I had no choice. I got so stressed when I did have to go that the anxiety would bring on a vertigo attack which, on one occasion I had to endure whilst on a busy rush-hour train. To tell the truth I avoided going anywhere with a lot of people, noise or movement for a while. Some days I was pretty scared to leave the house or walk down the street. The dizziness and motion I felt stole my confidence and made me want to hibernate home alone. I was transformed from being out and about all the time to a bit of a hermit.
Now I am lucky to have recovered so much that I was recently discharged from my neuro-otology appointments. That doesn’t mean that I don’t have symptoms everyday, but they are much more manageable. I have to work hard at physiotherapy, exercise and have regular Botox treatments, as well as take supplements that I find helpful and have research behind them for migraine and other conditions. I am also very aware of not engaging with activities that may be a trigger for an onset of worsening symptoms. Which is where travelling in London can, potentially, become a problem.
Thankfully, I have learnt a lot of tricks as to how to navigate London with a vestibular disorder so I rarely get a significant escalation of symptoms. Although each of us are at different stages of our healing, or management of symptoms, I hope that these strategies are helpful, whether you live in London, another city or in a quieter location.
The strategies I use to keep my vestibular disorder happy
1. My best piece of advice for navigating a city is to travel off-peak if it is possible. It makes a huge difference, as you are far more likely to get a seat on a train, bus or tube, and there will simply be less people, which means less noise and movement around you. Plus it’s cheaper, which is always good!
2. If travelling into the city is something you do less frequently, say once or twice a week (or less), then try and rest the day before if you can. I find that if I start the day already a bit more tired than usual, or my brain is already over-stimulated from the day before, then I struggle more. If you are anxious about being in the city, this is going to stress you out – so there will way too much stress and fatigue going on! Vestibular disorders and stress are not a goof combination. So have a quiet day the day before, and relax as much as possible.
3. On that note, getting prepared the day or night before is also something I find very helpful. I always plan my journey, buy train tickets, pack my bag, pick out clothes etc etc. It is far better to be prepared than running around in the morning trying to find your keys, wallet, phone and googling the tube map to work out which line gets you to your destination. Make the morning of your journey as easy as possible to keep those anxious thoughts at a minimum. And make sure you leave for the train with plenty of time, and factor in extra time when you arrive if you have an appointment so you won’t be rushing and worried about being late.
4. If you do have to travel at peak times, then consider getting one of the tfl (Transport for London) ‘please offer me a seat’ badges. Anyone can apply for one, and you don’t have to prove that you have a disability. It is self-selecting process and you just have to fill in some details - name, address etc. I have worn mine a few times, but haven’t actually had to use it in the sense of asking for a seat. I’ve just been lucky that there has been a seat free or I’m only going one stop so I can stand without any issue.
5. Another helpful tip that I do every single time I travel in London - walk up a train or tube platform so that you get on either at the first or last carriage. There is always a much higher chance of getting a seat. Plus you are less likely to end up with your face in someone's slightly sweaty armpit. Which is never a great way to commute . . .
6. Sit in the direction of travel. This is a HUGE thing for me. A few years I was on a train with allocated seating and I had to sit backwards. I asked to swap seats but it was a no. I arrived at my destination, took a few steps on solid ground and my head launched into a full-blown vertigo attack that lasted for hours. I sat in a hotel looking in the mirror seeing a perfectly well-looking person. The thunderstorm of vestibular migraine in my head was entirely invisible, but making such a massive impact on me. So now I always sit facing forwards, and if I can’t, I stand or, on one occasion, sat on the floor of the train (not that the latter is an ideal scenario).
7. If I can feel a migraine starting to bubble up, then I make sure to take preventative measures before travel. While Botox is my only migraine treatment at the moment, I also find that magnesium tablets are very useful. As set out by the Migraine Trust, two controlled trials have shown that oral magnesium supplementation is effective in headache prevention.
8. For days when pain is lower, but still distracting, I find that 4Head Stick is a nice non-pharmacological treatment. Inexpensive, and can be used alongside any prescribed medication, 4 Head Stick provides a cooling sensation to the forehead and helps block pain signals to the brain. Always worth a quick sweep across the forehead before going out!
9. I like a bit of distraction. Reading is a definite no, and has got me in vestibular disorder trouble before on a few occasions. So a book or magazine is out. Instead, music and podcasts are my favourite ways to pass the time. Meditation apps may also work quite nicely. Calming, quiet music is ideal for days when fatigue is higher, or perhaps a headache is present. Podcasts for when you are able to concentrate a little more and want to catch up on your favourite shows. Serial will always distract me enough to calm any nerves about my journey, at least temporarily!
10. Travel can be made easier by using nausea relief bands, or 'travel bands' as they are sometimes known. Using acupressure, they have been used for centuries and are an evidence-backed non-drug way of managing motion sickness. I like using the Blisslets nausea relief bands as they don't look medical at all, just like stylish jewellery.
Blisslets have kindly given me an affiliate code for 15% of their range with the code fibrofog
And my nemesis . . .
We all have a nemesis, I suspect. An activity that our personal vestibular systems do not enjoy, and will kick up a fuss about. Buses are my nemesis. Trains and I get on OK now. We have an agreement that as long as I do the things just outlined, we are on pretty good terms. Buses, on the other hand, are another story. For starters, buses move in a much more violent way, swinging around corners and roundabouts in a way that trains don’t tend to do. (Some) bus drivers like to accelerate quickly, or brake in dramatic style, the force of the speed of change propelling everyone – vestibular disorder or not – forward in their seats or stumbling on their feet grabbing for a rail to steady themselves. All of this, as I'm sure you know, is not a great situation for someone with a vestibular disorder.
Most of the time, if I am honest, I avoid buses at all costs. I prefer to walk or get the tube instead. But sometimes there is no option but to get a bus, especially outside of central London. So I find myself on a big red bus . . . I don’t have a lot of tips for this scenario other than to grab a seat if you can, not sit over the wheels and stick some noise cancelling headphones in as soon as possible. Personally I find looking out the window helpful, although others may find this a problem. So buses are something I am working on . . .
I hope those little tips for travel with migraine and vestibular disorders help if you have to navigate London or another city (or town). Let me know if you have any strategies that help you get around without stressing your vestibular system too much!
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