Non-pharmacological management of vestibular migraine: a systematic review of prospective studies on vestibular rehabilitation therapy
Abstract
Aim: Vestibular rehabilitation therapy (VRT) is recommended for vestibular migraine (VM); however, existing reviews include heterogeneous study designs, limiting the reliability of their conclusions. This systematic review evaluated the efficacy of VRT in adults with VM by restricting the analysis to prospective studies published between 2016 and 2026, with an exploratory consideration of its potential relevance to spa and health resort settings. Materials and Methods: A systematic search of PubMed and the Cochrane Library was conducted for studies published from January 2016 to May 2026. Inclusion criteria comprised adults (≥18 years) with a diagnosis of VM according to the Bárány Society/International Headache Society criteria, prospective study design, VRT as the primary or adjunctive intervention, and reporting of at least one standardized outcome measure. Retrospective studies, case reports, and narrative reviews were excluded. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results: Two prospective studies meeting all inclusion criteria were identified, comprising 311 participants overall, including 58 patients with VM. Both studies demonstrated statistically significant improvements in Dizziness Handicap Inventory (DHI) scores following VRT (p<0.001). Significant improvements were also observed in balance confidence, gait stability, activities of daily living, headache impact, and psychological well-being. Clinical improvements were reported following VRT used both as monotherapy and in combination with pharmacological treatment. Conclusions: Although based on a limited number of prospective studies, the available evidence suggests that VRT may reduce dizziness-related disability and improve quality of life in adults with VM. Future well-designed randomized controlled trials with standardized protocols, larger VM-specific cohorts, and long-term follow-up are urgently needed.