Symptomatic and functional outcomes of medical therapy alone versus sequential vestibular rehabilitation in patients with vestibular migraine

Background Vestibular migraine (VM) is a common cause of recurrent vertigo and is often challenging. While pharmacological therapy remains the mainstay, vestibular rehabilitation therapy (VRT) has been proposed as an adjunct. This study aimed to evaluate the effect of combined VRT and medical therapy compared to medical therapy alone on VM symptoms, vestibular, and audiological outcomes. Methods This prospective study was conducted on 42 adult patients diagnosed with VM. Patients were divided into two equal groups: Group A received topiramate 25 mg for 3 months, while Group B received topiramate for 1 month followed by 2 months of customized VRT. Clinical symptoms and vestibular assessments (VNG, vHIT) were assessed before and after treatment. Disability and quality of life were assessed using the Dizziness Handicap Inventory (DHI) and Headache Impact Test (HIT-6). Results Both groups demonstrated significant improvement in migraine-related symptoms, headache frequency, and vertigo attacks ( p < 0.05). Group A showed greater reduction in symptom severity, DHI, and HIT-6 scores compared to Group B ( p < 0.05). Vestibular outcomes showed partial improvements, with Dix-Hallpike responses significantly reduced only in Group B. Conclusion Topiramate monotherapy provided superior symptomatic and quality-of-life improvement compared to sequential topiramate-VRT therapy. VRT may be useful for patients with persistent imbalance, but its added benefit over medications alone was limited in this cohort.