Efficacy of Vestibular Rehabilitation in the Management of Vestibular Migraine: a Systematic Review and Meta-analysis
Bradley Ong1, Marina Vilardo2, Jad El Ahdab3, Neil Nero4, AHMET GÜNKAN5, Neil Cherian6, Julia Bucklan6
1Department of Neurology, Neurological Institute, Cleveland Clinic, 2Catholic University of Brasilia, 3Sleep Disorders Center, Neurological Institute, Cleveland Clinic, 4Education Institute, Floyd D. Loop Alumni Library, Cleveland Clinic, 5Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, 6Center for Neurological Restoration, Cleveland Clinic
Objective:
To evaluate the efficacy of vestibular rehabilitation in improving dizziness-related disability and quality of life in patients with vestibular migraine through a systematic review and meta-analysis.
Background:
Vestibular migraine (VM) is a common migraine subtype characterized by recurrent vestibular symptoms. Despite its prevalence, evidence-based treatment guidelines are lacking. Vestibular rehabilitation (VR) has been proven effective in many vestibular disorders, but its role in managing VM has not been well established. This systematic review aimed to evaluate the efficacy of VR for VM using standardized outcome measures, primarily focusing on patient-reported dizziness-related quality-of-life assessments.
Design/Methods:
We systematically searched MEDLINE, Embase, Cochrane Library, and Scopus for relevant studies evaluating self-reported and physical outcome measures of VR in patients with VM. Baseline characteristics, including sex and medication use, were analyzed using meta-analysis of proportions, while age and baseline Dizziness Handicap Inventory (DHI) scores were calculated as weighted averages. A random-effects model was applied using the inverse variance method to calculate standardized mean differences (SMDs) with 95% confidence intervals (CIs). Risk of bias was assessed using the ROBINS-I tool for observational studies.
Results:
Seven studies comprising 413 patients (mean age 45.5; 79% female) with VM treated with VR were included. Baseline DHI scores revealed a pooled mean of 55.56 (95% confidence interval (CI): 48.96–62.16). According to DHI scores, VR significantly reduced dizziness symptoms, with a pooled standardized mean difference (SMD) of 1.79 (95% CI: 0.83–2.75; p < 0.01), however, the very high heterogeneity (I² = 93%) suggests considerable variability among included studies.
Conclusions:
VR significantly improves dizziness-related quality of life in patients with VM, as indicated by improved DHI scores. However, considerable heterogeneity between studies highlights the need for further standardized randomized controlled trials to better determine the specific benefits and optimal protocols of VR in managing VM.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.