Early Experience Treating Vestibular Migraine With Small Molecule CGRP Antagonists

Area of Science:

• Neurology
• Pharmacology

Background:

• Vestibular migraine (VM) is a debilitating condition.
• Blocking calcitonin gene-related peptide (CGRP) is a potential therapeutic strategy for VM.

Purpose of the Study:

• To evaluate the effectiveness of small molecule CGRP antagonists (gepants) in treating VM.
• To assess patient-reported outcomes and tolerability of gepants for VM.

Main Methods:

• Retrospective case series at a tertiary academic center.
• Included adult patients diagnosed with VM treated with gepants (ubrogepant, rimegepant, atogepant, zavegepant).
• Utilized questionnaires including VM-PATHI, DHI, and surveys on VM details and gepant experience.

Main Results:

• 17 VM patients used gepants; vertigo was the most bothersome symptom for 47.1%.
• Rimegepant and ubrogepant were most commonly used; gepants were used abortively, preventatively, or both.
• 76.5% experienced relief of their most bothersome symptom, with 84.6% reporting significant symptom management.

Conclusions:

• Gepants are well-tolerated in VM patients.
• Small molecule CGRP antagonists demonstrate potential as effective treatments for vestibular migraine.