The Effectiveness of Vestibular Rehabilitation in Vestibular Migraine: A Systematic Review

This systematic review evaluates the effectiveness of vestibular rehabilitation (VR) in managing vestibular migraine (VM) symptoms in adults. A systematic search of PubMed, Web of Science, Scopus, ProQuest, ScienceDirect, and CENTRAL was conducted from inception to September 30, 2024. Additional searches included the NIH Clinical Trials Register and WHO ICTRP. Key search terms included: ("Vestibular migraine" OR "migraine-associated vertigo" OR "migrainous vertigo" OR "migraine-associated dizziness") AND ("Vestibular rehabilitation" OR "Vestibular exercis*" OR "balance rehabilitation" OR "balance physiotherapy" OR "exercis*"). Studies were excluded if they were non-English studies, irrelevant topics or unacceptable study types. Eligible studies included adults over 18 years diagnosed with VM based on Barany or Neuhauser criteria, excluding those with severe comorbidities or other causes of vertigo. Comparisons involved VR versus alternative treatments or controls, using outcome measures such as subjective scales (DHI, DGI, HADS) and performance tests. Data on design, sample size, age, sex, interventions, comparators, outcomes, results, and follow-up were extracted. Eleven studies (six prospective, three retrospective, two RCTs) with 977 participants (mean age 48.46) were analyzed. VR interventions included adaptation, substitution, habituation, balance, and gait exercises, delivered home-based, therapist-supervised, or combined. Significant improvements in vertigo, dizziness, imbalance, headache, anxiety, and depression were noted, with ten studies showing better DHI scores. However, high bias risk stemmed from limited randomization, blinding, and self-reported measures. In conclusion, VR proves to be effective for managing dizziness, balance, and psychological outcomes in VM, offering a non-pharmacologic option. Future research should prioritize standardized interventions, larger cohorts, and long-term follow-ups.