Migraine is a complex neurological condition involving more than just head pain. It is now understood as a disorder of sensory processing, where the brain becomes more sensitive to internal and external inputs. This can result in symptoms such as dizziness, visual sensitivity, neck pain, and balance difficulties.

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Importantly, up to 40% of people with migraine experience associated vestibular symptoms such as vertigo, motion sensitivity, and imbalance . For many individuals, these vestibular symptoms are not just associated features—they can act as powerful triggers, particularly in environments with high sensory demand (e.g. busy visual settings, head movement, or motion exposure).

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Migraine is best understood as a “sensitive brain”, where multiple triggers accumulate over time. As shown in the migraine threshold model below, once this threshold is exceeded, a migraine episode can occur . These triggers may include:

• Vestibular: head movement, travel, repetitive motion

• Visual: screens, bright lights, busy environments

• Auditory: loud or complex noise environments

• General: stress, fatigue, and sensory overload​

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Because of this complexity, migraine requires a multidisciplinary approach. Physiotherapy is one part of the team and works alongside GPs, neurologists, psychologists, and other health professionals to optimise outcomes.

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How Physiotherapy Can Help

Vestibular and upper cervical physiotherapy focus on how the brain integrates information from the inner ear, eyes, and neck. Disruption in this system can contribute to both dizziness and headache symptoms.

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The upper neck (C1–C3) is closely linked to headache pathways via the trigeminocervical complex, meaning dysfunction in this region can amplify migraine symptoms.

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Upper cervical physiotherapy aims to:

• Reduce neck-related pain and muscle tension

• Improve joint movement and posture

• Enhance cervical proprioception

• Reduce nociceptive input into headache pathways

Vestibular physiotherapy aims to:

• Reduce motion and visual sensitivity

• Improve balance and spatial awareness

• Retrain vestibular-ocular reflex function (gaze stability)

• Gradually desensitise the nervous system to triggers

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A Graded, Individualised Approach

Vestibular symptoms can occur at any phase of the migraine cycle (as shown in the phases diagram on page 2 of our handout) . For this reason, physiotherapy is carefully tailored and progressed gradually to avoid symptom flare-ups.

Treatment is always delivered within a broader plan that may include:

• Medical management (via your GP or neurologist)

• Lifestyle strategies (sleep, exercise, diet)

• Trigger identification (often using symptom diaries)

• Psychological support where required

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Our Approach

At VertiGO Physio & Rehab, we take a holistic, patient-centred approach to migraine management. By addressing vestibular and cervical contributors within a multidisciplinary framework, we aim to:

• Reduce migraine frequency and severity

• Improve tolerance to daily activities and environments

• Support long-term self-management and confidence