Combined biofeedback and vestibular rehabilitation therapy for vestibular migraine: clinical efficacy and neurobiochemical correlates.

BACKGROUND

Vestibular migraine (VM) is a prevalent cause of recurrent vertigo with limited standardized treatment options. While vestibular rehabilitation and biofeedback therapy have individually demonstrated efficacy, their combined application and effects on neurobiochemical markers remain unexplored.

METHODS

This prospective comparative study enrolled 148 patients with VM at a single tertiary center between January 2022 and March 2024. Patients were allocated to four groups (n = 37 each): routine intervention (Group A), vestibular rehabilitation (Group B), biofeedback therapy (Group C), or combined biofeedback and vestibular rehabilitation (Group D). Treatment efficacy, psychological outcomes (Hospital Anxiety and Depression Scale), vertigo disability (Dizziness Handicap Inventory), balance function (Berg Balance Scale), vestibular function parameters, cerebral blood flow velocities, and serum biomarkers (5-hydroxytryptamine, calcitonin gene-related peptide, γ-aminobutyric acid, and acetylcholine) were assessed at baseline and after 4 weeks.

RESULTS

Combined therapy achieved a significantly higher total effective rate (94.59%) compared to biofeedback (78.38%), vestibular rehabilitation (75.68%), and routine intervention (67.57%) (p = 0.035). The total effective rate was defined a priori as the proportion of patients whose headache, vertigo, and associated symptoms either resolved completely (markedly effective) or improved substantially (effective) relative to baseline. Group D demonstrated superior improvements in anxiety and depression scores, vertigo disability, and balance function compared to all other groups (all p < 0.001). Vestibular function parameters, including spontaneous nystagmus velocity, canal paresis, and directional preponderance, improved most substantially with combined therapy. Serum 5-hydroxytryptamine and γ-aminobutyric acid levels increased significantly, while calcitonin gene-related peptide and acetylcholine levels decreased, with the greatest modulation observed in the combined therapy group.

CONCLUSION

Combined biofeedback and vestibular rehabilitation therapy provides superior clinical efficacy and favorable neurobiochemical modulation in patients with vestibular migraine, supporting its application as a promising non-pharmacological treatment strategy.