Abstract Details

Title Efficacy of Vestibular Rehabilitation in the Management of Vestibular Migraine: a Systematic Review and Meta-analysis

Topic Headache

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 15-011

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.

Authors/Disclosures
Bradley G. Ong, MD (Cleveland Clinic Main Campus - Neurological Institute) PRESENTER	The institution of Dr. Ong has received research support from American Academy of Neurology. The institution of Dr. Ong has received research support from American Headache Society. Dr. Ong has received personal compensation in the range of $0-$499 for serving as a Expert Witness with Chandler Advocacy. Dr. Ong has a non-compensated relationship as a Editorial Board Member with Neurology Resident & Fellow Section that is relevant to AAN interests or activities. Dr. Ong has a non-compensated relationship as a Contributor with Neurology Minute that is relevant to AAN interests or activities.
Marina Vilardo	Miss Vilardo has nothing to disclose.
Jad El Ahdab, MD	Dr. El Ahdab has nothing to disclose.
Neil Nero, MLIS	Mr. Nero has nothing to disclose.
AHMET GÜNKAN, MD	Dr. GÜNKAN has nothing to disclose.
Neil Cherian, MD (Cleveland Clinic)	Dr. Cherian has nothing to disclose.
Julia N. Bucklan, DO (Cleveland Clinic)	Dr. Bucklan has nothing to disclose.