Vestibular Rehabilitation for Vestibular Migraine: A Systematic Review and Meta-Analysis

To evaluate the impact of vestibular rehabilitation (VR) on patient-reported outcome measures in adults with vestibular migraine (VM).

Medline, Embase, and Scopus were reviewed from database inception to May 2025. Additional citation searches were performed.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were used. Primary studies assessing VR in adults with VM diagnosed using ICHD-3 or equivalent criteria were included. The primary outcome was the change in the Dizziness Handicap Inventory (DHI) and the Activity-Specific Balance Confidence Scale (ABC). Mixed-effects modeling was used for the meta-analysis.

Seven studies comprising 272 participants were included. All studies demonstrated improvement in DHI following VR, with individual study treatment effects ranging from -10.57 to -44.7 points reduction. Meta-analysis showed a clinically significant pooled DHI reduction of -23.97 (95% CI: -33.31 to -14.62; P<0.0001). Heterogeneity was high (I2=96%), potentially due to patient selection, duration of disease, duration of VR, adjunctive therapies, timing of outcomes assessment, and VR protocol differences. Funnel plot asymmetry suggested small-study effect. Improvements in the ABC were reported but did not meet clinically significant thresholds.

On the basis of the included studies, VR is associated with clinically meaningful reductions in DHI among VM patients; however, effects on balance may not be clinically significant. Heterogeneity, limited data, as well as moderate and low quality of evidence for the available outcomes, highlight the importance of future large prospective studies with standardized VR protocols and outcomes.