Expert Migraine Treatment and Management Melbourne | Keilor Road Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on April 17, 2025
What are migraines?
Migraine is not only the most common neurological disorder globally but also a major disabling condition, especially impacting individuals aged 15-49. Migraine's complex nature has been documented since ancient times, with descriptions by Hippocrates and Aretaeus of Cappadocia noting not only the pain but also associated symptoms like visual auras, lethargy, and sensitivity to external stimuli (light, sound, and odors). These early observations underline that migraine is far more than just a headache; it involves significant neurological impairment.
Despite being a prevalent issue, migraine is frequently misunderstood by society at large and often inadequately managed within the healthcare system. At Keilor Road Physiotherapy, we approach migraine with a depth of understanding and a comprehensive treatment strategy that addresses both the symptoms and the underlying causes.
What causes migraines?
Modern science defines migraine as a disorder involving hyperactivity in the brainstem, specifically the Trigemino-Cervical Complex (TCC), which plays a critical role in the pain experienced during migraine attacks. This area of the brain becomes overly sensitive, leading to the classic symptoms of migraine, including severe headaches, nausea, and sensory sensitivities.
Migraine causes can be complex and vary from person to person. However, the most common triggers include:
Stress: Emotional and physical stress is one of the primary triggers of migraines.
Hormonal Changes: Women, in particular, may experience migraines due to hormonal fluctuations during menstruation, pregnancy, or menopause.
Dietary Factors: Certain foods, like chocolate, cheese, alcohol, and caffeine, can trigger migraines in some people.
Environmental Triggers: Bright lights, loud noises, or strong smells can lead to a migraine episode.
Genetics: A family history of migraines increases the likelihood of developing the condition.
By identifying your personal migraine triggers, you can take steps to reduce the frequency of attacks through better lifestyle choices, migraine prevention tips, and treatment options.
How to differentiate headaches from migraines
While migraines, cervicogenic headaches, tension headaches and cluster headaches share some common symptoms, the distinguishing factors lie in the origin of the pain, triggers, and associated symptoms:
Migraine:
Throbbing or pulsing headache, often on one side of the head.
Aura: Visual disturbances, such as flashing lights or blind spots.
Sensitivity to light and sound (photophobia and phonophobia).
Nausea and vomiting.
Cervicogenic headache:
Pain that starts in the neck and radiates to the head, typically on one side.
Neck stiffness and limited range of motion.
No nausea or visual disturbances like those found in migraines.
Tenderness in the upper neck, base of the skull, or shoulder area.
Tension headache:
Dull, pressing pain or tightness around the head (often like a band tightening around the forehead).
Pain may be bilateral (on both sides of the head).
No nausea or visual disturbances like those seen in migraines.
Mild sensitivity to light or sound in some cases, but typically less severe than in migraines.
Often triggered by stress, anxiety, poor posture, or muscle tension.
Cluster headaches:
Severe, sharp, and burning pain, typically around one eye, which can spread to the temple or jaw.
Episodes last 15 minutes to 3 hours, but occur frequently over several weeks (in "clusters").
Redness or watering of one eye, nasal congestion, or sweating on the face during an episode.
Unilateral pain, usually on one side of the head.
Differentiating these conditions is important for proper treatment. Physiotherapists are trained to assess whether neck issues are contributing to headaches, helping to guide effective migraine treatment or rule out other causes.
Recognising the symptoms of migraines
Understanding the different phases of migraine symptoms helps in managing the condition effectively:
Premonitory phase (Prodrome): Subtle changes that signal the onset of a migraine, such as mood changes, food cravings, or neck stiffness, occurring up to 72 hours before the headache.
Aura phase: Experienced by some sufferers, this phase involves reversible visual or sensory disturbances that precede the headache.
Headache phase (Ictal): This is the main phase, where the individual experiences the intense, often unilateral headache, which can be pulsating and is typically accompanied by nausea, as well as light and sound sensitivity.
Postdrome phase: After the headache subsides, this phase can still leave the sufferer feeling unwell or hungover, often described as not feeling "normal."
Interictal phase: The symptom-free period between attacks, which can be deceptive as brainstem activity may still be elevated.
If you experience these symptoms, especially recurrently, it’s important to consult with a healthcare provider for proper diagnosis and to start an appropriate migraine treatment plan.
How are migraines diagnosed?
Migraine is diagnosed based on criteria established by the International Classification of Headache Disorders (ICHD-3):
The ICHD-3 outlines the criteria for diagnosing episodic migraines (occurring less than 15 days per month) and chronic migraines (occurring 15 days or more per month for at least 3 months). Below are the key diagnostic criteria:
1. Attacks of Moderate to Severe Headache
The patient must experience at least two of the following characteristics:
Unilateral (one-sided) pain, though it can be bilateral in some cases.
Pulsating or throbbing pain.
Pain that is moderate to severe in intensity.
The pain is typically aggravated by physical activity (e.g., walking, climbing stairs).
2. Duration of the Headache
The headache lasts 4 to 72 hours if untreated.
3. Associated Symptoms
During a migraine attack, at least one of the following symptoms must be present:
Nausea and/or vomiting
Photophobia (sensitivity to light) or phonophobia (sensitivity to sound)
4. Exclusion of Other Conditions
A diagnosis of migraine is confirmed only after ruling out other possible causes of the headache. This may involve the use of imaging tests (such as MRI or CT scans) to exclude secondary causes of headache, such as tumours or stroke.
To be diagnosed with chronic migraines (which involves more frequent attacks):
The individual experiences headache episodes on 15 or more days per month for at least 3 months, and on at least 8 of those days, the attacks must meet the diagnostic criteria for migraine.
The ICHD-3 also includes subtypes of migraine, such as:
Migraine with Aura: A subtype of migraine where neurological symptoms (e.g., visual disturbances or sensory changes) precede the headache phase, often referred to as "aura."
Migraine without Aura: The most common type of migraine, where the headache is not preceded by aura symptoms.
Chronic Migraine: A migraine occurring on 15 or more days a month for at least 3 months.
In Australia, migraine affects approximately 22% of the population, significantly impacting daily life and productivity. The condition leads to considerable direct healthcare costs and lost productivity, emphasizing the need for effective management strategies.
The best treatment for migraines
1. Pharmacological Treatments
Pharmacological treatments are a cornerstone of migraine management. They are typically divided into two categories: acute (abortive) treatments and preventive treatments.
Acute (Abortive) Treatments:
These treatments are used to stop a migraine once it has started, providing relief from the pain and associated symptoms.
Triptans: Triptans (e.g., sumatriptan, rizatriptan, and zolmitriptan) remain a first-line treatment for acute migraines. These medications are serotonin receptor agonists that help to constrict blood vessels and reduce inflammation in the brain, providing relief from migraine pain. A recent study (Rushendran et al., 2025) suggests that newer triptan formulations, such as sumatriptan nasal spray or intranasal zolmitriptan, provide faster relief with fewer side effects compared to oral versions.
CGRP (Calcitonin Gene-Related Peptide) Antagonists: The development of CGRP antagonists, such as erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality), marks a significant advancement in migraine therapy. These medications are used as acute treatments to block the CGRP pathway, which plays a critical role in the pain process of migraines. Recent evidence indicates that CGRP antagonists can provide both acute and preventive benefits, significantly reducing the frequency and severity of migraines (Rushendran et al., 2025).
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs such as ibuprofen and naproxen remain commonly used for mild-to-moderate migraines. They are effective in managing pain when taken early in the attack (Weitzel et al, 1999).
Dihydroergotamine (DHE): DHE nasal spray or injections are used in cases where triptans are ineffective. DHE works by constricting blood vessels and has been shown to be effective in patients with medication-resistant migraines (Rushendran et al., 2025).
Preventive Treatments:
Preventive treatments are aimed at reducing the frequency of migraines and improving quality of life for people who experience chronic migraines (15 or more headache days per month).
CGRP Monoclonal Antibodies: These medications, including erenumab, fremanezumab, and galcanezumab, are not only used as acute treatments but also for preventive therapy. They are administered as monthly or quarterly injections and have shown promising results in reducing the frequency of migraine attacks (Rushendran et al., 2025). Studies have shown that these treatments can reduce the number of migraine days by up to 50% in many patients (Aditya et al., 2023).
Botox Injections: Botulinum toxin (Botox) has been FDA-approved for chronic migraine prevention. It is believed to work by blocking the release of certain chemicals that cause pain. A study by Pallapothu et al. (2023) demonstrated that Botox injections significantly reduced the frequency of migraine attacks in patients with chronic migraines.
Anti-Seizure Medications: Topiramate and valproate are both used as preventive treatments. These medications are effective for reducing migraine frequency, though side effects such as cognitive impairment and weight changes need to be considered (Rollo et al., 2023).
Beta-Blockers and Antidepressants: Beta-blockers such as propranolol and antidepressants such as amitriptyline are commonly prescribed for migraine prevention. They work by regulating blood flow and reducing nerve sensitivity. Recent studies (Rollo et al., 2023) confirm their continued effectiveness for preventing migraines, though they may have side effects like drowsiness and weight gain.
2. Non-Pharmacological Treatments
Advancements in non-pharmacological treatments have also contributed significantly to migraine management, offering patients a holistic approach.
Physiotherapy
Manual Therapy: Physiotherapists use techniques such as trigger point therapy, joint mobilisation, and soft tissue massage to treat neck-related tension and muscle tightness, which are often contributing factors in migraines. Recent evidence supports the efficacy of manual therapy in reducing both the intensity and frequency of migraines (Carvalho et al., 2020).
Postural Training and Exercise: Poor posture, particularly forward head posture, can lead to increased muscle tension in the neck and upper back, which may trigger or worsen migraine attacks. Physiotherapists work with patients to improve posture through specific exercises and stretches. Studies have shown that posture correction and strengthening exercises for the neck and upper back can significantly reduce migraine frequency (Carvalho et al., 2020).
Biofeedback and Cognitive Behavioural Therapy (CBT)
Biofeedback: This technique involves monitoring physiological functions like heart rate and muscle tension to help patients control stress levels. Research has shown that biofeedback can reduce migraine frequency and severity by teaching patients how to manage physiological responses to stress (Mullally et al., 2009).
Cognitive Behavioral Therapy (CBT): CBT focuses on changing negative thought patterns that may exacerbate migraine triggers, such as stress or anxiety. Recent studies (Bae et al., 2021) show that CBT can be as effective as pharmacological treatments for some individuals, especially when combined with relaxation techniques.
Acupuncture
Acupuncture has been increasingly studied for its potential to provide relief from migraine symptoms. Recent evidence suggests that acupuncture can help reduce the frequency and severity of migraines by promoting blood flow and relieving muscle tension (Urits et al., 2020). It is considered a safe and effective complementary treatment for migraines.
3. Lifestyle Modifications
Lifestyle modifications continue to play a critical role in migraine management. The latest advancements in migraine care emphasise the importance of a holistic approach, including:
Dietary Changes: Certain foods, such as chocolate, alcohol, and caffeine, are common migraine triggers. Recent studies have shown that a low-migraine trigger diet can help reduce migraine frequency (Hindiyeh et al., 2020).
Sleep Hygiene: Maintaining a regular sleep schedule is one of the most important factors in migraine prevention. Recent evidence highlights that sleep disturbances are linked to migraine onset and increasing sleep quality can help prevent attacks (Sullivan et al., 2019).
Stress Management: Techniques like meditation, yoga, and mindfulness are being integrated into migraine treatment plans to reduce the impact of stress, a major migraine trigger.
Advancements in migraine treatment over the past few years have provided a broader range of options for patients. CGRP inhibitors, Botox injections, biofeedback, and manual therapy are among the most promising developments in the field. Combining these treatments with lifestyle modifications, physiotherapy, and pharmacological therapies offers a holistic and effective approach to managing migraine symptoms.
Why choose Keilor Road Physiotherapy for migraine treatment?
At Keilor Road Physiotherapy, we specialise in migraine treatment Melbourne, offering personalised care that targets the root causes of your migraines. Our team of experienced physiotherapists uses evidence-based techniques, including the Watson Headache® approach:
The Watson Headache® approach
At Keilor Road Physiotherapy, we utilise the Watson Headache® Approach, a pioneering treatment that targets the sensitivity of the TCC. This approach is designed to reduce the hyperactivity of the brainstem, addressing one of the core mechanisms of migraine. Unlike general physiotherapy that may focus on symptom relief, the Watson Headache® Approach aims to modify the underlying dysfunction contributing to migraines.
This approach, in conjuction with specialised neck exercises, and posture correction, allows us to provide a holistic approach to migraine management. We strive to provide effective solutions to reduce migraine frequency and improve your overall well-being.
Top 10 tips for preventing migraines
1. Identify and Avoid Triggers
The first step in migraine prevention is identifying your personal migraine triggers. Common triggers include stress, certain foods (e.g., chocolate, cheese, alcohol), hormonal changes, and environmental factors like bright lights or loud noises. Keeping a migraine diary can help you track and avoid these triggers. Research suggests that managing trigger exposure can significantly reduce the frequency of attacks (Rushendran et al., 2025).
2. Maintain Regular Sleep Patterns
Sleep disturbances are a major contributor to migraine onset. Establishing a consistent sleep schedule and ensuring good sleep hygiene can help prevent migraine attacks. Aim for 7-9 hours of uninterrupted sleep per night. Poor sleep quality is strongly linked to migraines and improving sleep consistency has been shown to reduce migraine frequency (Sullivan et al., 2019).
3. Manage Stress Effectively
Stress is one of the most common migraine triggers. Managing stress through techniques such as mindfulness, deep breathing exercises, meditation, or yoga can significantly reduce the likelihood of migraine episodes. Studies have shown that relaxation techniques can be just as effective as medication for some individuals in preventing migraines (Bae et al., 2021).
4. Regular Physical Activity
Engaging in regular physical activity, such as walking, swimming, or cycling, can help reduce migraine frequency. Exercise helps to reduce stress and improve blood flow, both of which can mitigate migraine triggers. However, avoid overexertion, as intense exercise can sometimes provoke migraines. Moderate, consistent exercise is most beneficial for migraine prevention (Bae et al., 2021).
5. Stay Hydrated
Dehydration is a known migraine trigger. Ensuring you drink enough water throughout the day (aim for about 2-3 litres) can help prevent dehydration-related migraines. If you're active or in a hot climate, be sure to increase fluid intake accordingly. Hydration is often overlooked, but research suggests that maintaining fluid balance is essential for migraine management (Bae et al., 2021).
6. Avoid Certain Foods
Certain foods can act as migraine triggers. Common offenders include alcohol (especially red wine), caffeine, chocolate, aged cheeses, and foods with high levels of nitrates (like processed meats). By tracking your diet and eliminating known triggers, you can reduce the frequency of migraine attacks. Evidence-based dietary modifications have proven to be effective in managing migraines (Rushendran et al., 2025).
7. Try Physical Therapy
Physiotherapy has been shown to be a highly effective treatment for migraine prevention, especially for those with neck tension or posture-related issues. Manual therapy, neck exercises, and postural training can help reduce the physical tension that triggers migraines. Physiotherapists work with patients to improve alignment and strengthen the muscles of the neck and upper back, which can prevent the onset of migraine attacks (Carvalho et al., 2020).
8. Consider CGRP Monoclonal Antibodies
If you suffer from chronic migraines, CGRP monoclonal antibodies (e.g., erenumab, fremanezumab, and galcanezumab) may be a beneficial treatment. These medications block the calcitonin gene-related peptide (CGRP) pathway, which is involved in migraine pain. Clinical studies have shown that CGRP antagonists can reduce migraine frequency by up to 50% in many patients (Aditya et al., 2023).
9. Limit Overuse of Medication
Frequent use of pain relief medications can actually lead to medication-overuse headaches (MOH), which can worsen migraine symptoms. Be cautious about relying on painkillers or triptans for regular migraine relief. If you find yourself using these medications more than twice a week, it’s important to seek professional advice on how to break the cycle and reduce medication overuse (Aditya et al., 2023).
10. Botox Injections for Chronic Migraines
For individuals with chronic migraines (15 or more headache days per month), Botox injections are FDA-approved as a preventive treatment. Botox works by blocking the release of certain chemicals involved in the pain process. Studies have shown that Botox can significantly reduce migraine frequency and help patients lead a better quality of life (Pallapothu et al., 2023).
Migraine relief
Preventing migraines requires a multi-faceted approach that combines lifestyle changes, stress management, physical therapy, dietary adjustments, and, in some cases, pharmaceutical interventions.
At Keilor Road Physiotherapy, we offer personalised migraine management plans designed to address the unique triggers and symptoms of your migraines, helping you achieve long-term relief and improved quality of life.
If you’re looking for migraine relief in Melbourne, contact us today to book an appointment with one of our experienced physiotherapists.
References
Aditya, S., & Rattan, A. (2023). Advances in CGRP Monoclonal Antibodies as Migraine Therapy: A Narrative Review. Saudi journal of medicine & medical sciences, 11(1), 11–18. https://doi.org/10.4103/sjmms.sjmms_95_22
Bae, J. Y., Sung, H. K., Kwon, N. Y., Go, H. Y., Kim, T. J., Shin, S. M., & Lee, S. (2021). Cognitive Behavioral Therapy for Migraine Headache: A Systematic Review and Meta-Analysis. Medicina (Kaunas, Lithuania), 58(1), 44. https://doi.org/10.3390/medicina58010044
Carvalho, G. F., Schwarz, A., Szikszay, T. M., Adamczyk, W. M., Bevilaqua-Grossi, D., & Luedtke, K. (2020). Physical therapy and migraine: musculoskeletal and balance dysfunctions and their relevance for clinical practice. Brazilian journal of physical therapy, 24(4), 306–317. https://doi.org/10.1016/j.bjpt.2019.11.001
Hindiyeh, N. A., Zhang, N., Farrar, M., Banerjee, P., Lombard, L., & Aurora, S. K. (2020). The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review. Headache, 60(7), 1300–1316. https://doi.org/10.1111/head.13836
Mullally WJ, Hall K, Goldstein R. Efficacy of biofeedback in the treatment of migraine and tension type headaches. Pain Physician. 2009 Nov-Dec;12(6):1005-11. PMID: 19935987
Pallapothu, M. R., Quintana Mariñez, M. G., Chakkera, M., Ravi, N., Ramaraju, R., Vats, A., Nair, A. R., Bandhu, A. K., Koirala, D., & Mohammed, L. (2023). Long-Term Management of Migraine With OnabotulinumtoxinA (Botox) vs Calcitonin Gene-Related Peptide Antibodies (Anti-CGRP). Cureus, 15(10), e46696. https://doi.org/10.7759/cureus.46696
Rollo, E., Romozzi, M., Vollono, C., Calabresi, P., Geppetti, P., & Iannone, L. F. (2023). Antiseizure Medications for the Prophylaxis of Migraine during the Anti- CGRP Drugs Era. Current neuropharmacology, 21(8), 1767–1785. https://doi.org/10.2174/1570159X21666221228095256
Rushendran R, Vellapandian C. Advances in Migraine Treatment: A Comprehensive Clinical Review. Curr Protein Pept Sci. 2025 Jan 10. doi: 10.2174/0113892037329429241123095325. Epub ahead of print. PMID: 39810518
Sullivan, D. P., Martin, P. R., & Boschen, M. J. (2019). Psychological Sleep Interventions for Migraine and Tension-Type Headache: A Systematic Review and Meta-Analysis. Scientific reports, 9(1), 6411. https://doi.org/10.1038/s41598-019-42785-8
Urits, I., Patel, M., Putz, M. E., Monteferrante, N. R., Nguyen, D., An, D., Cornett, E. M., Hasoon, J., Kaye, A. D., & Viswanath, O. (2020). Acupuncture and Its Role in the Treatment of Migraine Headaches. Neurology and therapy, 9(2), 375–394. https://doi.org/10.1007/s40120-020-00216-1
Weitzel KW, Thomas ML, Small RE, Goode JV. Migraine: a comprehensive review of new treatment options. Pharmacotherapy. 1999 Aug;19(8):957-73. doi: 10.1592/phco.19.11.957.31569. PMID: 10453967.
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.