Does vestibular rehabilitation help patients with vestibular migraine? Is this also true if these patients have had a traumatic brain injury?
Reviewed by Aileen Lambert

Vestibular migraine (VM) is a common diagnosis in ENT, and there is growing evidence that vestibular rehabilitation therapy (VRT) is an effective treatment, reducing self-perceived dizziness and improving gait. This is a retrospective review of the outcomes of 93 patients with a diagnosis of vestibular migraine, from a tertiary vestibular rehabilitation physiotherapy clinic in the National Hospital of Neurology and Neurosurgery, UCLH, London. All patients had been diagnosed by an audiovestibular physician or neurologist, and had an average of four physiotherapy sessions. They describe the VRT as involving an individualised home exercise programme including exercises for gaze stabilisation, postural control, and visual desensitisation. All had been deemed to have well-controlled migraine management prior to starting therapy. The other arm in the study looked at outcomes of patients with traumatic brain injury-related dizziness after undergoing vestibular therapy (60 patients in total; 20 had both a diagnosis of VM and TBI). The results of this study support the existing literature regarding the role of VRT in vestibular migraine, with statistically significant improvements in the Dizziness Handicap Score, Gait Assessment, Severity and Impact VAS scales. Similar results were observed in patients with TBI dizziness alone undergoing VRT. The functional impact of these improvements moved the patients from the category of ‘fall risk’ to not being at risk of falls. However similar outcomes were not seen in patients with both a diagnosis of VM and a prior traumatic brain injury - the presence of migraine appears to have a significant, and negative impact on VRT outcomes. The possible reason for this difference in outcomes put forward by this paper relates to different pathophysiological processes in migraine following TBI, involving neuroinflammation, cortical spreading depolarisation, glutamate excitotoxicity, and diffuse axonal injury in functional regions of the brain. Despite the limitations of this retrospective study (particularly migraine medication dose/type, overall numbers in each group, no control group to assess natural history of recovery etc.) it lends support to the role of VRT for patients with vestibular migraine.

Vestibular Rehabilitation Therapy for the Treatment of Vestibular Migraine, and the Impact of Traumatic Brain Injury on Outcome: A Retrospective Study.
Stancel-Lewis J, Wai Ling Lau J, Male A, et al.
OTOL NEUROTOL
2022;43(3):359-67.