Tertiary Care With or Without Manual Therapy for Chronic Migraine

Inclusion Criteria: Female adults 18 years of age or older with a good command of English (to enable informed consent) Existing patients with chronic migraine as diagnosed by a clinical interview with a neurologist in line with the International Classification of Headache Diagnosis criteria (ICHD) Undergoing care as usual from the neurologist Exclusion Criteria: Currently having or had manual therapy for neck, shoulder in the last six weeks. Having a condition contraindicated for manual therapy including but not limited to inflammatory disorders, severe osteoporosis and tumours. Identification of any medical 'red flags' by the neurologist including * Evidence of any central nervous system involvement for example: * Facial palsy (presence of ptosis/Horner's syndrome) * Visual disturbance (presence of blurred vision, diplopia, hemianopia) * Speech disturbance (presence of dysarthria, dysphonia, dysphasia such as expressive or receptive) * Balance disturbance (presence of dizziness, imbalance, unsteadiness, falls) * Paraesthesia (presence, location such as upper limb/lower limb, face) * Weakness (presence, location such as upper limb/lower limb) * Known major psychiatric or psychological conditions not under control