SynthesisBMC neurology2025
Comparative effectiveness and safety of preventive treatments for vestibular migraine: a systematic review and network meta-analysis.
Synthesis in BMC neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
4 citing papers in PubMed.
- Vestibular Migraine: A Systematic Literature Search and Narrative Review of Diagnostic Criteria, Pathophysiology, Differential Diagnosis, and Treatment Approaches.Medeniyet medical journal · 2026Article
- CGRP-Targeted Therapy in Vestibular Migraine-How Strong Is the Evidence?European journal of neurology · 2026Review
- Integrative phytochemical profiling and systems pharmacology identify ERBB2-MAPK1-AKT1 signaling as a molecular basis for the anti-vertigo effects of Ziyin Zhixuan Decoction.Biochemistry and biophysics reports · 2026Article
- Phenotype-guided selection of venlafaxine and topiramate for vestibular migraine: a narrative review.Frontiers in neuroscience · 2026Review
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundVestibular migraine causes recurrent vertigo attacks that significantly impact quality of life. While various preventive medications are used, their comparative effectiveness was unknown. Previous systematic reviews have been limited by pairwise comparisons only or exclusion of newer treatments. The lack of head-to-head trials comparing all available treatments further complicates evidence-based decision-making. This evidence gap has real-world consequences, has also substantial economic burden of Vestibular migraine. There is a need for direct comparison studies between the most promising treatments to provide clearer guidance for clinical practice.
objectiveTo determine the comparative effectiveness and safety of preventive treatments for vestibular migraine through systematic review and network meta-analysis. Given the lack of head-to-head randomized trials, a network meta-analysis (NMA) provides the most appropriate method to compare available treatments by combining both direct and indirect evidence.
methodsWe searched Embase, Scopus, PubMed, and Cochrane Library from inception to January 15, 2025. We included randomized controlled trials (RCTs) and prospective observational studies (n ≥ 30 for CGRP antagonists) comparing preventive treatments for vestibular migraine diagnosed according to either Bárány Society/International Headache Society criteria (post-2012) or Neuhauser criteria (pre-2012). Primary outcomes were monthly vertigo frequency and quality of life (DHI scores). We conducted frequentist network meta-analysis and assessed certainty using GRADE.
resultsFrom 340 identified records, nine studies met inclusion criteria. Five RCTs (419 patients) comparing seven treatments were included in the network meta-analysis. All treatments significantly reduced monthly vertigo attacks versus control. Propranolol ranked highest (P-score: 0.794; -7.04 attacks/month, 95% CI -12.77 to -1.31), followed by valproic acid (-5.95, 95% CI -9.01 to -2.89) and venlafaxine (-5.94, 95% CI -8.98 to -2.90). Galcanezumab showed moderate efficacy (-5.80, 95% CI -10.61 to -0.99) with zero discontinuations. Network heterogeneity was negligible (τ²<0.001). Evidence certainty was moderate for galcanezumab and low to very low for other treatments.
conclusionsAll evaluated treatments effectively reduce vertigo frequency in vestibular migraine. While propranolol showed the largest effect, this relied on indirect evidence. Galcanezumab offers the best balance of efficacy, tolerability, and evidence quality. Head-to-head trials are urgently needed. PROSPERO REGISTRATION: CRD420251089507.
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