Evaluating the Efficacy and Safety of Preventive Therapies for Vestibular Migraine: A Systematic Review and Network Meta-Analysis
By
Sindhu Vasireddy
Shankar Biswas
Raja Kollu
Elangovan Krishnan
Mohammed Semaal Khan
Fasil C
Arjun Jayakumar
Reena Acharya
December 30, 2025
Clinical Scorecard: Evaluating the Efficacy and Safety of Preventive Therapies for Vestibular Migraine: A Systematic Review and Network Meta-Analysis
At a Glance
Category Detail
Condition Vestibular Migraine Key Mechanisms CGRP monoclonal antibodies and traditional migraine preventives Target Population Adults (≥ 18 years) with vestibular migraine Care Setting Clinical settings with access to preventive treatments
Key Highlights
All medications significantly reduced vertigo attacks. Propranolol showed the largest benefits among traditional migraine preventives. CGRP antibody galcanezumab demonstrated the strongest evidence quality and best tolerability. Network meta-analysis allows for indirect comparisons of treatments. Direct comparison studies are needed for clearer clinical guidance. Guideline-Based Recommendations
Diagnosis
Diagnosis according to Bárány Society/International Headache Society criteria or Neuhauser criteria. Management
Consider traditional preventive medications and CGRP antagonists for treatment. Monitoring & Follow-up
Monitor change in monthly vertigo frequency/days and quality of life. Risks
Potential for bias in diagnostic definitions and treatment comparisons. Patient & Prescribing Data
Adults with vestibular migraine, 1-3% prevalence in the general population.
Preventive treatments administered for ≥ 12 weeks, including beta-blockers, calcium channel blockers, antidepressants, anticonvulsants, and CGRP antagonists.
Clinical Best Practices
Utilize network meta-analysis for comprehensive treatment comparisons. Balance effectiveness with evidence quality and side effects in treatment selection. Encourage further research on head-to-head comparisons of promising treatments. References
