Headache and migraine assessment and treatment.

Migraine is more than “just a headache”. It is a neurological disorder that can involve moderate to severe head pain, nausea, sensitivity to light or sound, visual symptoms, dizziness, and worsening with normal activity. Some people also notice neck discomfort, fatigue, or difficulty concentrating. Physiotherapy may not replace medical diagnosis or migraine medication management, but assessment when your migraine is accompanied by headache neck pain, dizziness, motion sensitivity, visual strain, or difficulty returning to normal activity is paramount to treat and manage your migraine.

Some people experience migraine with aura, where temporary neurological symptoms come on gradually and are fully reversible. Aura may include flashing lights, blind spots, tingling, numbness, or changes in speech, and is often followed by headache, although it can happen without headache as well. Because aura can overlap with other neurological presentations, an accurate medical diagnosis is important, especially if symptoms are new, prolonged, or unusual for you.

Menstrual migraine refers to migraine attacks that occur around menstruation. In the International Headache Society classification, menstrual attacks most often occur in the window from two days before bleeding starts to three days after it begins, and they commonly happen without aura. Tracking symptoms in a diary can be useful when this pattern is suspected. Physiotherapy can still be relevant if menstrual migraine occurs alongside neck discomfort, dizziness, reduced activity tolerance, or difficulty managing daily function, but medical guidance remains important.

Hemiplegic migraine is a type of migraine with aura that includes temporary motor weakness, along with other possible symptoms such as visual changes, sensory symptoms, or speech disturbance. The weakness is reversible, but episodes can be alarming and may overlap with other neurological conditions. Medical assessment is important, particularly if symptoms are occurring for the first time or feel different from your usual pattern. Physiotherapy can play a supportive role in the management of symptoms once the condition has been properly assessed.

Vestibular migraine can involve dizziness, vertigo, imbalance, motion sensitivity, or discomfort in busy visual environments, with or without a prominent headache. Episodes can last from minutes to hours, and the pattern often overlaps with other vestibular or neurological conditions. Assessment is important when dizziness occurs alongside a history of migraine, visual sensitivity, balance problems, or difficulty tolerating movement and everyday environments. Vestibular, ocular and cervical rehabilitation may be considered as one part of care when assessment identifies relevant vestibular or motion-sensitivity problems.

Abdominal migraine is a recognised migraine-related disorder seen mainly in children. It usually involves recurrent episodes of moderate to severe midline or poorly localised abdominal pain, often with nausea, vomiting, pallor, and normal periods between episodes. Headache is typically not the main feature during the attack. Because other gastrointestinal causes need to be ruled out, medical assessment is important.

Cyclic vomiting syndrome is another recognised migraine-related disorder, usually involving repeated episodes of intense nausea and vomiting with complete recovery between attacks. It is more common in childhood, although it can occur in adults. The episodes tend to be stereotyped for the individual person and may seem to follow a pattern. Because other gastrointestinal and medical causes need to be excluded, medical diagnosis is essential.

Tension-type headache commonly feels like pressure, tightness, or a band-like ache around the head or in the temples. It is often milder than migraine, but it can still affect concentration, energy, and daily function. It is usually pressing or tightening rather than throbbing, is often not worsened by routine activity, and may occur with neck or shoulder discomfort. Tension-type headache is not simply caused by “tight muscles”, and symptoms can overlap with other headache types, so assessment is still important.

Cluster headache is a severe headache disorder that usually causes intense one-sided pain around the eye, temple, or forehead. Attacks may be accompanied by watering of the eye, eyelid drooping, a blocked or runny nose, or marked restlessness. These attacks often occur in bouts or “clusters” with some type of cyclical pattern.

Persistent symptoms after concussion are sometimes still referred to as post-concussion syndrome. Headache is one of the most common ongoing symptoms, but it rarely has a single explanation. In some people, the pattern resembles migraine or cervicogenic headache, while in others it may also involve dizziness, visual symptoms, balance problems, exercise intolerance, fatigue, or difficulty returning to work, school, or sport. Physiotherapy assessment and treatment can help identify whether cervical, vestibular, oculomotor, exercise-tolerance, or pacing factors are contributing to ongoing symptoms, then using these findings, successfully treat the symptoms.