VERTIGO / NAUSEA

Managing Functional Neurological Disorder (FND) with Vertigo and Nausea

Vertigo and nausea are distressing but common symptoms in Functional Neurological Disorder (FND). These symptoms may resemble vestibular or gastrointestinal disorders but are driven by functional (rather than structural) brain changes. They can be constant or episodic, and often flare with stress, movement, fatigue, or sensory input.

Understanding FND-Related Vertigo and Nausea

Vertigo May Present As:

• Spinning sensation (internal or external)

• Feeling off-balance or like walking on a boat

• Lightheadedness or “floating”

• Visual blurring or motion sensitivity

Nausea May Present As:

• Chronic or episodic queasiness

• Sensitivity to smells or motion

• Reduced appetite or food aversion

• Sometimes linked with gut symptoms (IBS overlap)

Triggers Include:

• Visual or auditory overload

• Head or body movement

• Postural changes (standing up)

• Fatigue, dehydration, low blood sugar

• Anxiety, dissociation, or overstimulation

Management Strategies

1. Vestibular Rehabilitation Therapy (VRT)

• Provided by a physiotherapist trained in vestibular disorders

• Gentle, graded head and eye exercises

• Helps retrain the brain to interpret balance signals correctly

2. Occupational Therapy

• Sensory adaptation tools (sunglasses, hats, earplugs)

• Strategies to avoid environmental overload

• Activity pacing and upright tolerance training

3. Movement & Positioning Tips

• Move slowly when changing positions

• Anchor vision on a fixed point when dizzy

• Avoid quick turns or sudden head movements

• Use support when walking during flares

4. Dietary & Hydration Support

• Small, frequent meals with light, bland food

• Stay hydrated—consider electrolyte drinks

• Avoid caffeine, alcohol, and spicy or greasy food

5. Grounding & Sensory Regulation

• Practice grounding techniques when disoriented

• Use cold compresses or peppermint for nausea relief

• Try acupressure bands (like SeaBands) or ginger lozenges

6. Speech & Communication Support (if needed)

• Vertigo/nausea can be overwhelming—speech may slow or pause

• Allow extra time for response

• Use alternative tools (text, cards) during severe symptoms

Medications (If Needed)

• Use only as a short-term bridge—not a cure

• Options may include:

  • Prochlorperazine or ondansetron for nausea

  • Betahistine or meclizine for vertigo (short term)

  • Low-dose SSRIs/SNRIs if anxiety is a major trigger

Flare-Up Toolkit

• Sit or lie in a quiet, dark room

• Focus vision on one object or close eyes gently

• Use cold packs or fresh air

• Sip electrolyte water

• Use motion sickness tools (SeaBands, ginger gum)

• Text or use cards to communicate if speech is difficult

When to Escalate

• New or worsening symptoms that mimic stroke (e.g., facial droop)

• Severe dehydration or inability to keep fluids down

• Loss of ability to walk safely or risk of falls

• Persistent vomiting or confusion

Multidisciplinary Support

• Neurologist: Rule out vestibular or structural causes

• Physiotherapist (Vestibular): Re-training and exercises

• Occupational Therapist: Sensory tools, pacing

• SLT (if needed): Communication and swallowing

• Primary Care Provider: Symptom monitoring and medication

• Psychologist: Address anxiety, dissociation, and trauma

Vertigo and nausea in FND are disruptive but manageable. With gentle rehabilitation, sensory strategies, and compassionate care, these symptoms often improve significantly over time.