Our Expert Team at Corrective Spinal Rehab

• At Corrective Spinal Rehab, our multidisciplinary team comprises highly qualified and internationally recognised professionals, including Licensed Physiotherapists (PT), a Doctor of Physical Therapy (DPT), a Doctor of Chiropractic (DC), and a Doctor of Osteopathy (DO). Together, we bring a wealth of advanced clinical knowledge in neuro-orthopaedic manual therapy, spinal biomechanics, pain science, and functional rehabilitation.

• This integrative team collaborates to ensure that every migraine management plan is underpinned by cutting-edge evidence, precision diagnosis, and bespoke treatment. By uniting expertise from physiotherapeutic, chiropractic, and osteopathic disciplines, we offer a unique and highly effective approach to spinal and neurological disorders, including migraines with cervicogenic components.

Q: What Causes Migraines?

• Migraines are a complex neurovascular disorder characterised by recurrent episodes of moderate to severe, often unilateral, throbbing head pain. While the precise pathophysiology remains multifactorial and incompletely understood, migraines are thought to arise from aberrant cortical and brainstem excitability leading to dysfunctional trigeminovascular signalling. This cascade includes dysregulated neurotransmitter release (e.g., CGRP, serotonin), altered vascular tone, and central sensitisation involving the trigeminal nucleus caudalis.

• Physiologically, migraines involve a transient disruption in sensory processing networks, likely initiated by genetic and environmental factors. Common triggers include hormonal fluctuations, sleep disturbances, dietary agents, sensory overstimulation, and psychosocial stress. Importantly, these triggers vary between individuals, necessitating a personalised diagnostic and management approach.

• From a manual therapy and rehabilitation perspective, musculoskeletal contributors such as upper cervical joint dysfunction, myofascial trigger points in the cranio-cervical musculature, and impaired neuromechanical integrity of the cervicothoracic spine are commonly observed in patients presenting with migraines. Trigeminocervical convergence explains why nociceptive input from cervical afferents (especially C1–C3) may amplify or perpetuate migraine symptoms, making this system a clinically significant target in physiotherapeutic care.

Q: How Are Migraines Diagnosed?

• Migraine diagnosis is principally clinical and based on established criteria outlined in the International Classification of Headache Disorders (ICHD-3). However, in a multidisciplinary musculoskeletal setting, a more functional diagnostic process is adopted to identify coexisting neuro-biomechanical dysfunctions.

• A thorough physiotherapy assessment involves:

  • Comprehensive history taking to identify symptom patterns, triggers, medication use, family history, and comorbidities.

  • Postural and structural analysis, including digital posture assessment and weight-bearing distribution.

  • Cervical spine joint integrity testing via manual palpation, segmental motion analysis, and pain provocation tests.

  • Neurological screening to evaluate upper cervical nerve root irritability, cranial nerve involvement, and proprioceptive deficits.

  • Myofascial examination, identifying active or latent trigger points, particularly in the suboccipitals, temporalis, upper trapezius, and SCM.

  • Assessment of inflammation and autonomic signs, such as skin sensitivity and vasomotor changes.

• This integrative approach facilitates identification of cervicogenic contributions and central sensitisation features, allowing a tailored intervention plan.

Common Symptoms of Migraines

• Migraine symptoms extend beyond simple head pain and reflect a systemic and neurological disturbance. Clinically reported symptoms include:

  • Unilateral pulsatile headache, often escalating with activity

  • Pain at the base of the skull, radiating superiorly

  • Pericranial tenderness, particularly in the temporal and occipital regions

  • Orbital or retro-orbital pressure, sometimes perceived as eye strain

  • Cutaneous allodynia and scalp sensitivity

  • Photophobia, phonophobia, and osmophobia

  • Prodromal symptoms such as mood changes, fatigue, and food cravings

  • Aura phenomena, including visual distortions, paresthesia, or aphasia (in some cases)

  • Autonomic signs like facial pallor, tearing, or nasal congestion

  • Nausea and vomiting

  • Dizziness, vertigo, or vestibular imbalance

  • Facial muscle tension or postural asymmetries, including exaggerated frowning or jaw clenching

• Persistent symptoms and chronicity (≥15 headache days/month for >3 months) suggest chronic migraine and require multidisciplinary intervention.

Effective Migraine Treatment: A Multidisciplinary, Manual Therapy-Focused Approach

• Management of migraines in a physiotherapy and rehabilitation context aims to reduce episode frequency, intensity, and disability by addressing underlying neuromechanical dysfunctions.

• Following a detailed assessment, the following strategies are commonly employed:

  • Spinal mobilisation and manual therapy targeting C0–C3 segments to reduce mechanical irritation and facilitate neuromodulation through the trigeminocervical complex.

  • Myofascial release techniques to deactivate trigger points and restore functional muscle length in the upper cervical and craniofacial muscles.

  • Neurodynamic techniques to reduce mechanosensitivity in cervical nerve roots and improve neural tissue mobility.

  • Postural re-education and ergonomic correction, particularly in patients with forward head posture or thoracic kyphosis.

  • Cranial nerve facilitation techniques where indicated, especially when symptoms suggest dysfunction in cranial nerve V (trigeminal) or XI (accessory).

  • Sensorimotor retraining to improve cervicocephalic kinaesthetic awareness and vestibular balance.

  • Patient education on migraine triggers, sleep hygiene, hydration, and psychosocial stress management.

  • Nutritional and lifestyle counselling, often in collaboration with dietitians and psychologists, to mitigate inflammatory and hormonal triggers.

• Individual responses to physiotherapy vary. Some patients experience complete resolution or significant reduction in migraine episodes, while others report moderate improvement. Ongoing collaboration with neurologists, GPs, and other allied health professionals remains essential for optimal care.