The 56-year-old star, whose tumble has become a viral hit online, said the Armani cape she was wearing was tied too tight because choreographers did not want it to fall off, and she denied it was a publicity stunt.
Appearing on the Jonathan Ross show, she said: "I didn't hurt my butt, I hurt my head. I did. I know how to fall, I've fallen off my horse many times. I tucked and I have good core strength.
"But the thing is, I had a little bit of a whiplash and I smacked the back of my head. So there was a man standing over me with a flashlight until about 3am making sure I was still conscious."
The singer, who said she was "a creature of habit", said the problems were caused because her performance was different to the rehearsal.
She said: "I was told to tie my cape and start much further back than I had rehearsed and because I hadn't walked so much further everyone was worried that my cape was going to slide off because it was quite heavy. They tied it really tightly around my neck.
"So here I am marching in like the Queen and I got to the top of the stairs and I pulled my silky string and it did not come undone. And my two lovely Japanese dancers basically strangled me off the stage. I had a choice - I could either de-strangle or fall with the cape, and I fell."
The star, who joked "cape fear is over", was closing the Brit Awards ceremony when the gaffe took place.
:: The Jonathan Ross Show Madonna Special will be broadcast on ITV on Saturday March 14
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