The effect of vestibular rehabilitation in the management of vestibular migraine in adults: 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 summarize and pool the evidence on the effectiveness of VR for VM using standardized outcome measures, primarily focusing on patient‐reported dizziness‐related quality‐of‐life assessments. Methods We systematically searched MEDLINE, Embase, Cochrane Library, and Scopus from inception to March 2025 for studies evaluating self‐reported and physical outcome measures of VR in patients with VM. Meta‐analysis of mean change in Dizziness Handicap Inventory (DHI) scores was performed. Risk of bias was assessed using the Cochrane RoB 2 tool for the randomized controlled trials and the ROBINS‐I tool for observational studies. Results Seven studies comprising 413 patients (mean age, 45.4; 76% female) with VM treated with VR were included. The effect of vestibular rehabilitation on DHI scores showed a pooled mean difference of −29.3 (95% confidence interval [CI], −40.2 to −18.3), more than the clinically important difference of 18 points. Although, our meta‐analysis had high heterogeneity (Cochran's Q p value <0.001, I 2 = 94.7%). Conclusion VR demonstrated a reduction in DHI scores, meeting the clinically significant difference of 18 indicating clinical improvement. However, the considerable heterogeneity limits the generalizability of these results and highlights the need for further standardized randomized controlled trials with subgroup analyses to better determine the specific benefits and optimal protocols of VR in managing VM.