Vestibular Therapy: How it Helps Migraines, Tinnitus, Dizziness and Vertigo (BPPV)

What Is Vestibular Therapy?

Vestibular therapy, or vestibular physiotherapy as it is often referred to, is a form of treatment that aims to address primary and secondary problems related to vestibular pathology.

This means that vestibular therapy can help those who are experiencing symptoms directly from a problem with the vestibular system (BPPV, Ménière’s disease, vestibular neuritis, etc.) or experiencing symptoms due to another condition affecting the vestibular system (migraines, ear infections, etc.).

What Is The Vestibular System?

Basically, vestibular therapy aims to help problems with our vestibular system. This system is also known as the ‘system of balance’. Its main components are actually found in the inner ear, consisting of a complex interconnected system named the ‘vestibular labyrinth’ – our semicircular canals, otolith organs, and receptors for all the sensations of balance that come in through the ear. These sensations get sent to the brainstem, the parts of the brain that control active movements of the body, and even to the eyes.

When our inner ear works well, we are able to balance ourselves well, even when external forces are placed against us (e.g. walking on a wobbly surface, or righting ourselves after tripping over a rock). When this system is damaged, we have difficulty controlling our eye movements when our head is moving, and our sense of balance becomes negatively affected, especially when we change positions suddenly – from sleeping, to sitting up, or from lying down to standing up.

There are several clinical assessments like the Epley’s manoeuvre that can be done in our initial consultation session, which can help to identify whether you have a true vestibular problem that requires a visit to the ENT, or whether it is one of the kinds of conditions which our physiotherapists can treat in the clinic itself.

Can Vestibular Therapy Help Dizziness And Vertigo (BPPV)?

Firstly, one should understand the difference between dizziness and vertigo.

Dizziness is classified into 4 categories: Vertigo, Pre-Syncope, Disequilibrium, and Psycho-physiological. Pre-syncope relates to fainting (can be blood pressure related), disequilibrium means a general unsteadiness from vision or brain disorders, psycho-physiological is induced by anxiety or extreme emotions.

Vertigo is a subset under dizziness – usually provoked by head movements (turning in bed, looking up), it causes a ‘spinning’ feeling of either the individual, or the surroundings.


When an individual is experiencing BPPV (benign paroxysmal positional vertigo), the crystals in their inner ear are displaced. Physiotherapy for vertigo will look a lot like identifying which positions your vertigo is triggered, and then applying certain movement principles to help with returning the crystals to their intended position. It may also involve improving the muscle tension around the neck and jaw.

Can Vestibular Therapy Help Migraines?

If you find that having a severe headache or migraine is often accompanied by feeling dizzy when you try to get up from the bed, they may be related.

Migraines are often neurological in nature, meaning that there is some nerve sensitivity around the neck, head, and jaw. When triggered due to factors like stress, heat, or excessive bright lights and sound, it can affect the nerves which connect to the inner ear resulting in dizziness along with migraines.

For such cases, vestibular therapy can focus on eye gaze stability exercises, relieving tension in the neck and jaw, and improving the overall strength of your head and neck muscles which can help to reduce sensitivity of triggers.

Can Vestibular Therapy Help Tinnitus?


Tinnitus is the perception of sound even when there is the absence of any external auditory stimulus happening. Tinnitus needs a proper assessment from an ENT or audiologist to rule out any middle ear conditions that require medical treatment.
If your tinnitus increases in correlation with increased dizziness in certain positions (e.g. appearance of tinnitus during positional vertigo in BPPV sufferers, such as lying down and tilting/rotating head backwards), then vestibular therapy which targets the BPPV may help – improving positional vertigo may reduce occurrence of tinnitus.

How Long Does Vestibular Therapy Take To Work?

The most common type of condition that those requiring vestibular therapy need is BPPV, where small calcium crystals get loose in the inner ear and affect the equilibrium of your vestibular labyrinth. This is the easiest type of vertigo to treat, and you can see changes in one session if you have a true BPPV condition.

Other conditions where your dizziness is secondary to a vestibular issue, then it may take several weeks of gradual progression for you to improve on your eye gaze stability and balance in your daily life. Just like building muscle, improving balance may take time to find which works best for you, which is why having a certified physiotherapist guiding you makes the journey easier.

Are There Any Side Effects of Vestibular Therapy?

The only side effects you might feel from vestibular therapy is a temporary increase in dizziness during or right after the session, which should go off within the hour. There are no side effects of increased pain or stiffness that you need to worry about! If you are worried or unsure, just discuss your concerns with the therapist.

Can I Do Vestibular Rehabilitation Exercises At Home Or Do I Need Supervision?

Vestibular rehabilitation exercises may look different for different individuals.

There may be balance exercises, where you may or may not need to have your eyes closed. Other exercises include those which can reduce gaze instability (if your eye gaze is affected and contributing to dizziness), and motion sensitivity desensitisation exercises like Brandt-Daroff exercises.

Depending on what you need, these will be assessed during your physiotherapy session itself, and if you are cleared for it then you can do them at home without supervision.

If you are looking for a consultation to identify if vestibular therapy exercises can help your migraines, tinnitus, or vertigo, contact us for more information or to book an appointment at your desired day and time.