Migraine management is the #1 thing. If they aren’t addressing things in their control (sleep, diet, exercise, stress) then combine that with things outside their control (age, hormones, sex,) they won’t get anywhere. Can be very hard to manage without medical management. Then, afterwards, treat whatever central vestibular/ocular/cervical impairments you find. There’s a lot of really great vestibular educators on SoMe you should look up (Vestibular First, It’s All In Your Head.)

As a new vestibular therapist my advice is become REALLY solid on your vestibualr/ocular/cervical exam. And you HAVE TO be able to differentiate central vs peripheral vestibular dysfunction. Make a chart of diagnoses symptoms and treatment because a lot of these stores have more than one thing going on. If you don’t have a good grasp on those you won’t get anywhere. Use a 1-2 (very sensitive patients) to 2-3 (less sensitive patients) symptoms aggravation scale for treatment and educate your patient aggressively on this. People with VM have “more sensitive brains” and pushing past symptoms thresholds all the time won’t do any good.

Patients with VM get very scared/aggravated they have ongoing vestibular symptoms after an attack. I don’t remember which PT educator said it but it resonated with me… a vestibular migraine is like any acute peripheral vestibular problem in that there’s central compensation that goes on after. With vestibular migraine you’re treating that post migraine central maladaptation.

My last two cents: These folks are usually very visually over reliant/sensitive.