Prophylactic Management of Vestibular Migraine: A Systematic Review
Abstract
BACKGROUND: Vestibular migraine (VM) is a neurological disorder characterized by episodic vertigo in patients with migraine, contributing to substantial functional impairment. Although VM is relatively common, a consensus on effective prophylactic treatments is lacking. This systematic review aimed to evaluate the efficacy and safety of pharmacological and adjunct non-pharmacological interventions for VM management.
METHODS: The systematic review was conducted following the PRISMA 2020 guidelines. PubMed, Web of Science, and Google Scholar were searched from inception to April 2025. Randomized controlled trials or cohort (retrospective and prospective) studies assessing prophylactic pharmacological or adjunct non-pharmacological management in adults diagnosed with VM were included. The risk of bias was evaluated using the Cochrane RoB 2 and MINORS tools.
RESULTS: Nine studies (three RCTs, six cohort studies; total n = 687) met the inclusion criteria. Beta-blockers, particularly propranolol, and antiepileptics, such as topiramate, consistently reduced VM symptoms, as measured using validated scales (Dizziness Handicap Inventory, Vertigo Symptom Scale, and Vestibular Activities of Daily Living). Anti-CGRP monoclonal antibodies (erenumab and galcanezumab) showed favorable efficacy and tolerability. By contrast, calcium channel blockers and antidepressants yielded inconsistent outcomes. Vestibular rehabilitation, when used as an adjunct therapy, demonstrated functional benefits.…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 687 participants or records.
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