Exploring the effectiveness of neuromodulation techniques in the diagnosis and management of vestibular disorders and migraine and its relevance to vestibular migraine

Vestibular Migraine (VM) is a complex neurological disorder characterized by episodic vertigo and migraine-like symptoms and is often misdiagnosed due to overlapping features with other vestibular and neurological conditions. In this review, we systematically explored the efficacy of exogenous (e.g., repetitive transcranial magnetic stimulation (rTMS) and transient DC Stimulation (tDCS)) and endogenous (e.g., EEG and infra-low frequency neurofeedback) neuromodulation techniques in diagnosing and managing vestibular disorders and migraines, with its relevance to VM. Analysis of 30 selected studies demonstrated promising outcomes in symptom reduction, with notable effectiveness in refractory and chronic cases. Studies involving both neuromodulation techniques improve various symptoms of vestibular disorders and migraine, positioning neuromodulation as a valuable adjunct to the available standard care being employed with patients. Given the pathophysiological overlap between migraine and vestibular dysfunction, particularly involving cortical excitability, GABAergic inhibition, and hypothalamic-trigeminal dysregulation, neuromodulation offers a non-invasive, safe, and targeted approach for long-term VM management. Further high-quality clinical trials are warranted to establish standardized protocols and confirm the long-term efficacy of these neuromodulation modalities.