Can Physiotherapy Treat Your Vestibular Migraine?
What is a Vestibular Migraine?
A vestibular migraine is a neurological condition which is not well understood. It is thought to be caused by a hyperexcitability of nerve cells which causes a widening of the blood vessels in the brain which affects how information is processed.
It includes the common features of migraine such as headache, light sensitivity (photophobia), and sound sensitivity (phonophobia) but also includes vestibular symptoms like:
Vertigo: A sensation of spinning or movement
Imbalance/Unsteadiness: Feeling wobbly or unsteady on your feet.
Nausea and Vomiting (often triggered by motion).
The vertigo symptoms associated with vestibular migraine can be worsened by motion or movement of the head and/or eyes.
Understanding Your Triggers
Vestibular migraines are highly multifactorial and are often set off by a combination of factors that cause a heightened sensitivity in the brain. Identifying and managing these triggers is key to long-term control. Common triggers include:
Dietary: Certain food groups, alcohol, caffeine
Sensory: bright lights and loud noises
Physical/lifestyle: lack of quality sleep, dehydration and stress
Hormonal: fluctuations related to the menstrual cycle, peri-menopause or menopause
The Multifactorial Treatment Approach
Effective treatment for vestibular migraine requires a comprehensive approach and, in some cases, cooperation amongst several healthcare professionals. Professionals involved in migraine care can include your GP, a Neurologist, and, when relevant, a Psychologist.
Treatment often includes:
Medications (such as triptans, beta-blockers, anti-depressants and anti-convulsants) or supplements (such as Vitamin B2, Magnesium, and Coenzyme Q10).
Lifestyle Changes: Avoiding known triggers, effectively managing stress, and promoting good sleep hygiene.
The Specific Role of Physiotherapy
Physiotherapists work specifically with patients suffering from vestibular migraine by gradually and progressively retraining the nervous system to be less sensitive to motion and visual input.
1. Habituation exercises
Habituation exercises desensitise the nervous system to motion which can decrease sensitivity to motion triggers, thereby improving daily functioning and quality of life.
2. Gaze stability exercises
Gaze stability exercises help your eyes maintain visual stability when your head is moving, a process essential for reducing dizziness and unsteadiness.
3. Addressing the link with the neck
In some cases, the upper neck (specifically the top three levels of the neck) can contribute to vestibular migraine symptoms. Sensory signals from stiff or painful neck joints feed directly into the brainstem, acting as a powerful sensitising factor. We use gentle manual therapy and targeted exercises to manage the neck dysfunction.
4. Education and Lifestyle Guidance
Physiotherapists empower you to manage your condition daily by providing advice on sleep hygiene, stress management, and a safe, graduated return to regular exercise.
🛑 Red Flag Symptoms: When to Seek Emergency Care
While vestibular migraine is a common cause of chronic dizziness, its symptoms can sometimes mimic a stroke or other serious acute neurological events. It is vital to recognize red flag symptoms that require immediate, urgent medical care.
Seek immediate medical attention if you experience any of the following new or sudden symptoms:
A New and Severe Headache (often described as the "worst headache of your life").
Sudden Numbness, Weakness, or Paralysis in the face, arm, or leg
Double Vision that is new or persistent.
Slurred or Confused Speech
Sudden Difficulty Walking or loss of coordination, making it impossible to stand or move.
Dizziness that is significantly worse than your usual symptoms, particularly if accompanied by any of the above.
Acute Change in Alertness or Consciousness.
Conclusion: Taking Control of Your Vestibular Migraine
Vestibular migraine is a complex condition, but it is highly manageable. While it can involve medical, dietary, and lifestyle factors, the addition of specialised physiotherapy can be the key to long-term relief.
By addressing the neck, reducing triggers and retraining your nervous system with specific habituation and gaze stability exercises, a vestibular physiotherapist empowers you to reduce your sensitivity to movement and get back to living without constant dizziness.With a collaborative approach involving your doctor and a vestibular physiotherapist, you can find your way back to a stable, confident life.