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

Dinesh Bhatia; Koyel Das; Tania Acharjee; Henry Benson Nongrum; Dinesh Bhatia; Koyel Das; Tania Acharjee; Henry Benson Nongrum

doi:10.3934/biophy.2025013

AIMS Biophysics

2025, Volume 12, Issue 2: 220-257. doi: 10.3934/biophy.2025013

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Review

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

1.
Department of Biomedical Engineering, North Eastern Hill University (NEHU, A Central University), Shillong 793022, Meghalaya, India
2.
Department of ENT, Nazareth Hospital, Shillong, Meghalaya, India

Received: 20 January 2025 Revised: 26 April 2025 Accepted: 08 May 2025 Published: 19 May 2025

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.
- vestibular migraine,
- repetitive transcranial magnetic stimulation (r-TMS),
- Transcranial Direct Current Stimulation (t-DCS),
- neuromodulation,
- migraine episode,
- inhibition,
- exogenous,
- endogenous
Citation: Dinesh Bhatia, Koyel Das, Tania Acharjee, Henry Benson Nongrum. Exploring the effectiveness of neuromodulation techniques in the diagnosis and management of vestibular disorders and migraine and its relevance to vestibular migraine[J]. AIMS Biophysics, 2025, 12(2): 220-257. doi: 10.3934/biophy.2025013

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Abstract

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.

Abbreviations

ABEP

Auditory Brainstem Evoked Potential

AICA

Anterior Inferior Cerebellar Artery

CMCT

Central motor conduction time

CSF

Cerebrospinal Fluid

CSSP

Cortical Stimulation Silent Period

CSD

Cortical Spreading Depression

DBS

Deep brain stimulation

DHI

Dizziness Handicap Index

DLFPC

Dorsolateral Prefrontal Cortex

EMG

Electromyography

ICHD

International Classification of Headache Disorders

MEP

Motor-evoked potentials

MdDS

Mal de debarquement syndrome

MIDAS

Migraine Disability Assessment Scale

MVS

Magnetic Vestibular Stimulation

SOC

Superior Olivary Complex

rTMS

Repetitive Transcranial Magnetic Stimulation

rMT

Resting motor threshold

PCS

Persistent post-concussion syndrome

Just above the occipital point

RCT

Randomized Controlled Trials

sTMS

Single-Pulse Transcranial Magnetic Stimulation

tDCS

Transcranial Direct Current Stimulation

TVS

Trigeminovascular system

TBI

Traumatic Brain Injury

TES

Transcranial Electromagnetic Stimulation

TVS

Trigeminovascular system

Vestibular Migraine

VRT

Vestibular Rehabilitation Therapy

VPN

Ventral Posteriomedial Nucleus

VNG

Videonystagmography

ILF

Infra-Low frequency

Acknowledgments

The authors acknowledge the support of library resources and facilities available at the North Eastern Hill University (NEHU), Shillong, Meghalaya, India and Nazareth Hospital, Shillong, Meghalaya, India, in preparation of this comprehensive review on exploring the effectiveness of neuromodulation techniques in the vestibular disorders and migraine and its relevance to VM. The authors acknowledge and express their sincere gratitude to all concerned individuals for their support and cooperation in the preparation of this manuscript for more than a year.

Conflict of interest

The authors report no conflicts of interest in the preparation of this manuscript.

Author contributions

The authors made substantial contributions to the conception or design of the work, as well as the acquisition, analysis, or interpretation of data. These contributions are as follows:
Conceptualization: Dinesh Bhatia and Koyel Das; Methodology: Koyel Das and Henry Benson Nongrum; Validation: Dinesh Bhatia, Koyel Das, and Tania Acharjee; Formal Analysis: Dinesh Bhatia and Koyel Das; Investigation: Dinesh Bhatia and Koyel Das; Resources: Dinesh Bhatia and Koyel Das; Data Curation: Dinesh Bhatia and Koyel Das; Visualization: Dinesh Bhatia, Tania Acharjee, Koyel Das; Writing Contributions: Original Draft Preparation: Koyel Das and Henry Benson Nongrum; Review and Editing: Dinesh Bhatia and Tania Acharjee.

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