CGRP-Targeted Therapy in Vestibular Migraine-How Strong Is the Evidence?

CGRP-targeted therapies have shown promise in reducing migraine symptoms for many patients. However, evidence for their effectiveness in vestibular migraine is limited and preliminary. Current literature on vestibular migraine prevention with monoclonal antibodies and gepants is sparse. Eight studies reviewed reported improvements in vestibular symptoms and related scores. Many of these studies had small sample sizes, lacked blinding, and had retrospective designs. A randomized controlled trial showed significant responses to galcanezumab for dizzy days. The effect size ranged from medium to large, indicating potential benefits. However, data on anti-CGRP treatments for vestibular migraine is still not robust. Differences in migraine types mean that findings from headache migraine may not apply. Initial treatment effect estimates might decrease over time due to various biases. While targeted treatments are needed for vestibular migraine, the evidence available must be interpreted carefully. Clinical relevance: This research indicates that CGRP-targeted therapies may not be universally effective for vestibular migraine.