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CGRP-Targeted Therapy in Vestibular Migraine-How Strong Is the Evidence?
Alexander Andrea Tarnutzer1,2, Patricia Castro Abarca3,4, Diego Kaski4
1Neurology, Cantonal Hospital of Baden, Baden, Switzerland.
European Journal of Neurology
|July 3, 2026
Summary
New CGRP medications show promise for vestibular migraine (VM) but require careful interpretation. Limited data and study biases mean current findings on monoclonal antibodies (mAbs) and gepants for VM may need further validation.
Area of Science:
- Neurology
- Ophthalmology
Background:
- Calcitonin gene-related peptide (CGRP) pathway inhibitors offer new migraine prevention strategies.
- Data on CGRP-targeting monoclonal antibodies (mAbs) and gepants for vestibular migraine (VM) are limited.
Purpose of the Study:
- To review the existing literature on the efficacy of mAbs and gepants in preventing VM.
- To identify biases and limitations in current VM treatment research.
Main Methods:
- Systematic review of 8 studies assessing mAbs and gepants for VM.
- Focus on study design, sample size, blinding, and patient selection.
Main Results:
- Most studies reported improvements in vestibular symptoms and related scores.
- Small sample sizes and lack of blinding were common limitations.
- One randomized controlled trial showed significant efficacy for galcanezumab in reducing dizzy days.
Conclusions:
- Evidence for anti-CGRP treatments in VM is preliminary and requires cautious interpretation.
- Efficacy in headache migraine may not directly translate to VM due to differing pathophysiology.
- Potential for overestimation of treatment effects due to novelty and expectancy biases.
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