BACKGROUND

Vestibular migraine (VM) is a leading cause of recurrent vertigo episodes. Voxel-based morphometry (VBM) is a reliable technique to analyze structural changes, particularly in gray matter (GM) volume, across various neurological conditions. Despite the growing amount of neuroimaging data in recent decades, a comprehensive review of GM alterations in VM remains lacking.

METHODS

We conducted a systematic review of three English-language databases (PubMed, Embase, and Web of Science) and two Chinese-language databases (China National Knowledge Infrastructure and Wanfang) to evaluate existing neuroimaging data on GM volume in VM patients. A coordinate-based meta-analysis (CBMA) was performed using the latest algorithm, seed-based d mapping with permutation of subject images (SDM-PSI), to identify brain alterations across individual studies.

RESULTS

Five studies (103 VM patients, 107 HCs) were included. The CBMA demonstrated a significant reduction in GM volume in VM patients compared to HCs, with peak convergence in the left rolandic operculum (SDM-Z = -3.68, -corrected = 0.004, voxels = 629; Brodmann area 48), extending to the posterior insula. Heterogeneity across studies was low (I = 19.35%), and no publication bias was detected (Egger's test:  = 0.826).

CONCLUSION

This meta-analysis confirms reliable GM volume alterations in the posterior insula-operculum region of VM patients. Longitudinal studies with standardized imaging protocols are needed to clarify whether these changes are causes or consequences of VM.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier CRD42021277684.