OBJECTIVE: To systematically evaluate the effect of acupuncture combined with Western medicine on vertebrobasilar artery hemodynamics and its clinical efficacy in patients with cervical vertigo. To provide a reliable evidence-based medical basis for the clinical treatment of CV. METHODS: This systematic review and meta-analysis will be reported in agreement with the Meta-Analyses (PRISMA2020) statement. MEDLINE, Embase, Web of Science, the Cochrane Library, CNKI, VIP, Wan Fang, and China Biology Medicine Disc (CBM) were searched until August 20, 2024. The quality of the included studies was assessed using the Cochrane Collaboration's tool for assessing the risk of bias, and the data were analyzed using Revman5.4, StataMP 18, and TSA0.9.5.10Beta software. RESULTS: A total of 7 randomized controlled trials involving 714 patients were included. The meta-analysis results showed that acupuncture combined with Western medication was superior to simple Western medication in improving the blood flow velocity of the left vertebral artery, right vertebral artery, and basilar artery in patients with CV, improving the symptoms of cervical vertigo and improving its function and clinical efficacy. TSA analysis results again confirmed the robustness of the results of this meta-analysis. CONCLUSION: Acupuncture combined with Western medicine has measurable benefits in improving vertebrobasilar hemodynamics and clinical efficacy in patients with CV, with certain safety. However, there are still methodological defects such as small sample size, different acupuncture treatment methods, and information on minimal clinically relevant differences is missing. In the future, RCTs with larger sample sizes and longer observations are still needed to further verify the efficacy of acupuncture combined with Western medicine, and an updated meta-analysis can be conducted to analyze the efficacy of acupuncture combined with Western medicine in the treatment of CV. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024592131.