Virtual Reality-Based Vestibular Rehabilitation for Vestibular Migraine: A Randomized Trial.

OBJECTIVES: To evaluate whether virtual reality-based vestibular rehabilitation (VR-VestRehab) added to home-based vestibular rehabilitation (HB-VestRehab) improves postural control, symptom severity, and psychological outcomes in vestibular migraine (VM). METHODS: This prospective, single-blind randomized controlled trial enrolled 40 patients (18-60 years) with definite VM (ICHD-3), randomized 1:1. Both groups received 4 weeks of vestibular rehabilitation; the VR-VestRehab group additionally underwent 8 clinic-based virtual reality sessions (30 min, twice weekly) using the Virtualis MotionVR system. DHI, a registered secondary outcome, was designated as the principal outcome for this report; SOT, LOS, and fHIT were the registered primary outcomes (see Methods). Other secondary outcomes were patient-reported measures (VAS, ABC, VADL, FGA, DGI, HADS). RESULTS: DHI was significantly lower in VR-VestRehab at post-treatment (p = 0.005), with a reduction exceeding the 18-point MCID; dizziness VAS was also lower (p = 0.041). LOS endpoint excursion, maximum excursion, and directional control were significantly higher in VR-VestRehab (p = 0.007, 0.003, < 0.001). In a change-score sensitivity analysis, the advantage persisted for DHI (p = 0.033), dizziness VAS (p = 0.012), and LOS directional control (p < 0.001). No between-group differences were found in SOT composite score or fHIT parameters, except right lateral canal fHIT correct-answer percentage (p = 0.019, exploratory). Both groups improved significantly within groups across nearly all measures. CONCLUSION: Adding virtual reality-based rehabilitation to home exercise provides additional benefits in symptom severity (DHI) and dynamic postural control (LOS) in vestibular migraine, while functional and psychological gains were shared by both groups. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT07493005.