Effects of adding transcutaneous vagus nerve stimulation to vestibular rehabilitation on dizziness and postural control in vestibular migraine: a randomized clinical trial

Vestibular migraine (VM) causes episodic dizziness and imbalance, yet treatment options remain limited. Although management often follows migraine protocols, vestibular and headache symptoms may not coincide. While vestibular rehabilitation (VR) is a noninvasive approach to improve balance, transcutaneous auricular vagus nerve stimulation (taVNS) has shown promise in migraine relief and may influence vestibular function. This parallel-group randomized clinical trial investigated the combined effects of VR and taVNS on postural control and migraine-related symptoms in VM patients. Twenty-eight participants were randomly assigned to four groups: VR, taVNS, VR plus sham-taVNS, and VR plus taVNS. The one-month intervention included daily VR exercises and twelve 30-minute taVNS sessions targeting the cymba conchae. Outcomes comprised postural control parameters under four conditions as primary outcomes, and video head impulse test gain, Dizziness Handicap Inventory, Vertigo Symptom Scale–short form, vertigo/dizziness and headache frequency, and Headache Impact Test (HIT-6) scores as secondary outcomes. All groups showed significant improvement (p < 0.05), but VR plus taVNS produced the most consistent gains across postural and symptom measures. Groups receiving taVNS had greater reductions in headache frequency and HIT-6 scores (p < 0.05). Postural improvement moderately correlated with decreased vertigo/dizziness frequency. Combining taVNS with VR may enhance balance and symptom relief in VM.