Vestibular Migraine as a Central Multisensory Disorder: Clinical Phenotypes, Diagnostic Physiology, and Therapeutic Evidence from a PRISMA Systematic Review
Abstract
Background Vestibular migraine (VM) is one of the most common causes of episodic vertigo but remains underdiagnosed and frequently misclassified as a peripheral vestibular disorder. Increasing evidence suggests that VM involves abnormal central integration of vestibular, visual, and auditory sensory inputs rather than primary labyrinthine dysfunction. Recent advances in clinical phenotyping, diagnostic physiology, and targeted therapeutics have immensely improved the understanding of VM pathophysiology. Objective To systematically review and synthesize original full-text evidence examining vestibular migraine in relation to central multisensory integration, with specific emphasis on clinical phenotypes, diagnostic physiological findings, and therapeutic outcomes. Methods A PRISMA 2020–guided systematic search of PubMed and Cochrane CENTRAL was conducted from database inception to January 2025. Only original full-text studies involving adults with vestibular migraine defined by established diagnostic criteria were included. Eligible studies addressed clinical characteristics, diagnostic physiology, treatment outcomes, or hormonal mechanisms. Risk of bias was assessed using ROB-2 and ROBINS-I tools. Due to heterogeneity, data were synthesized narratively. Results Thirteen original full-text studies met inclusion criteria. Clinical investigations demonstrated marked phenotypic heterogeneity, including motion-sensitivity–dominant, positional-vertigo–dominant,…
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Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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