The neurological pillar is at the heart of Dr. Harcourt’s work in functional neurology. The idea is straightforward: if parts of the brain are processing information inefficiently, targeted exercises can help them work better and reduce the load on the system.

Why the brain can be retrained

The brain changes with repetition, a property called neuroplasticity. Because migraine involves the brainstem, cerebellum, vestibular system and sensory pathways ¹, exercises that challenge these areas can be used to strengthen them.

Common therapies

• Gaze stability exercises (horizontal and vertical): keeping your eyes on a target while your head moves, to improve the vestibulo-ocular reflex
• Eye movement training: tracking, saccades and convergence (focusing up close). A manual therapy approach to the muscles that move the eyes improved migraine outcomes in a preliminary study ².
• Vestibular rehabilitation: exercises for dizziness and balance, shown to help people with vestibular migraine ³
• Proprioceptive therapy: improving the brain’s sense of body position
• Balance and coordination exercises
• Peripheral nerve stimulation and other gentle sensory inputs

The Harcourt Method in practice

Exercises are chosen based on the directions of dysfunction found on the Harcourt Method test and the full exam (see Your first visit). Progress is re-tested regularly, usually every couple of weeks, and the exercises are made more complex and more intense as you improve.

Vestibular stimulation

• Caloric vestibular stimulation, which gently changes inner ear temperature, reduced migraine days in a trial ⁴.
• Trigeminal nerve stimulation affected vestibular responses in people with migraine ⁵.

Special cases

• Vestibular migraine: often misdiagnosed for years, it responds well to a combined approach ^6,3.
• Hemiplegic migraine: Dr. Harcourt considers clinical neuroscience a particularly important part of treatment, alongside the other pillars.
• Concussion-related headache: treated with the same neurological principles ⁷.

Home exercises

Most neurological therapies include a home program. Doing your exercises consistently is one of the biggest predictors of progress.

Research cited on this page

1. Goadsby PJ, Holland PR, Martins-Oliveira M, et al. Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiol Rev. 2017;97(2):553-622. PubMed 28179394 · DOI
2. Rodríguez-Almagro D, Barassi G, Bertollo M, et al. Manual Therapy Approach to the Extraocular Muscles in Migraine Treatment: A Preliminary Study. Adv Exp Med Biol. 2022;1375:29-37. PubMed 35147929 · DOI
3. Alghadir AH, Anwer S. Effects of Vestibular Rehabilitation in the Management of a Vestibular Migraine: A Review. Front Neurol. 2018;9:440. PubMed 29946294 · DOI
4. Wilkinson D, Ade KK, Rogers LL, et al. Preventing Episodic Migraine With Caloric Vestibular Stimulation: A Randomized Controlled Trial. Headache. 2017;57(7):1065-1087. PubMed 28656612 · DOI
5. Marano E, Marcelli V, Di Stasio E, et al. Trigeminal stimulation elicits a peripheral vestibular imbalance in migraine patients. Headache. 2005;45(4):325-31. PubMed 15836568 · DOI
6. Beh SC, Masrour S, Smith SV, et al. The Spectrum of Vestibular Migraine: Clinical Features, Triggers, and Examination Findings. Headache. 2019;59(5):727-740. PubMed 30737783 · DOI
7. Kamins J, Charles A. Posttraumatic Headache: Basic Mechanisms and Therapeutic Targets. Headache. 2018;58(6):811-826. PubMed 29757458 · DOI