Repetitive transcranial magnetic stimulation for vestibular migraine in women of reproductive age: a retrospective propensity score-matched study.

BACKGROUND

Vestibular migraine (VM) substantially impairs quality of life, particularly in women of reproductive age. While repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising non-invasive neuromodulation therapy, its efficacy for VM remains underexplored.

METHODS

In this retrospective study, we analyzed data from 83 women of reproductive age diagnosed with VM who were treated between June 2022 and October 2024. After propensity score matching, 34 patients who received rTMS combined with pharmacotherapy were compared with 34 patients who received pharmacotherapy alone.

RESULTS

At the 3-month follow-up, the rTMS group demonstrated a significant reduction in headache-related impact compared to the control group, as measured by HIT-6 (46.50 [43.00, 52.50] vs. 53.50 [50.00, 58.75], P-holm < 0.001), with a moderate effect size (r = 0.49, 95% CI: 0.31, 0.67). In contrast, no significant between-group differences were observed in pain intensity (VAS: 4.00 [3.00, 4.00] vs. 4.00 [4.00, 5.00], P-holm = 0.054) or dizziness handicap (DHI-T: 23.82 ± 3.39 vs. 25.88 ± 4.26, P-holm = 0.09). Within-group analyses revealed that the rTMS group exhibited continued improvement over time across both pain and vertigo measures.

CONCLUSION

These findings indicate that as an adjunct to pharmacotherapy, rTMS offers significant benefits in alleviating pain-related functional impairment over a 3-month period in women of reproductive age with VM, although it confers no additional advantage over pharmacotherapy alone in reducing pain intensity or vertigo symptoms.