Early Experience Treating Vestibular Migraine With Small Molecule CGRP Antagonists

Blocking the activity of calcitonin gene-related peptide (CGRP) has emerged as a possible method for the prevention of vestibular migraine (VM). We aimed to investigate the effectiveness of small molecule CGRP antagonists (gepants) for the treatment of VM.

Retrospective case series.

Tertiary academic center.

Adult patients diagnosed with VM who were treated with gepants were included. The gepants used included ubrogepant, rimegepant, atogepant, and zavegepant. A set of questionnaires was sent to patients including the Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI), Dizziness Handicap Inventory (DHI), a survey regarding the details of their VM, and a survey focused on their experience with gepants.

A total of 17 patients with VM who used gepants were included. Median age was 54.1 (SD 9.3) and the majority were female (70.6%). Vertigo was the most bothersome symptoms for 47.1% of patients. The most common gepant used was rimegepant (88.2%) followed by ubrogepant (58.8%), atogepant (23.5%), and zavegepant (5.9%). Seven patients (41.2%) took gepants in an abortive fashion, 3 patients (17.6%) used them as a preventative medication and 7 patients (41.2%) tried them as both a preventative or abortive medication. The majority of patients (76.5%) experienced relief of their most bothersome symptom after taking a gepant and 84.6% of this cohort claimed these medications helped quite a lot to manage their symptoms of VM. No serious adverse events were observed.

Gepants are well-tolerated by patients and are promising agents for the treatment of vestibular migraine.