A small new study has found that a class of migraine medications known as gepants may provide meaningful relief for people living with vestibular migraine (VM), a condition characterised by episodes of dizziness, vertigo, and balance disturbances.
The findings, published in a study titled 'Early Experience Treating Vestibular Migraine With Small Molecule CGRP Antagonists', published in Otolaryngology Head and Neck Surgery, suggest that these medications are generally well tolerated and may help address both acute vestibular symptoms and long-term disease management.
What is vestibular migraine?
Vestibular migraine is considered the most common cause of recurrent spontaneous vertigo. Patients can experience debilitating episodes of dizziness, imbalance, motion sensitivity, and vertigo, often with or without the severe headaches typically associated with migraine.
Despite its prevalence, the condition remains underdiagnosed and undertreated. While several medications used for conventional migraine are also prescribed for vestibular migraine, effective treatments for stopping acute vestibular attacks have been limited.
Previous clinical trials of triptans, which are widely used migraine medications, have not consistently demonstrated benefit for vestibular symptoms, say doctors, and this is the gap gepants may help to fill.
Gepants are a newer class of medications that work by blocking calcitonin gene-related peptide (CGRP), a molecule known to play a central role in migraine attacks.
Researchers note that CGRP is also present throughout the body's vestibular system, which helps regulate balance and spatial orientation. This biological connection has led scientists to investigate whether blocking CGRP could alleviate vertigo and dizziness in addition to migraine pain.
Unlike injectable CGRP-targeting monoclonal antibodies, gepants are available as oral tablets or nasal sprays, potentially making them more convenient for many patients.
"CGRP has emerged as a major factor in the pathogenesis of migraine. Our previous work showed in a randomized clinical trial that CGRP monoclonal antibodies were more effective than placebo in treating vestibular migraine. This current study looked at gepants in a retrospective fashion and found that a significant percentage of patients with vestibular migraine thought they were helpful," said corresponding author Dr Jeffrey D. Sharon of the University of California, San Francisco.
He added that larger prospective studies are needed, but current evidence suggests it is reasonable to consider gepants as a treatment option for vestibular migraine.
The study included 17 adults diagnosed with vestibular migraine who had been treated with one or more gepants. Participants had a median age of 54 years, and about 71 per cent were women. Nearly half reported vertigo as their most troublesome symptom. The medications used included Rimegepant (88.2 per cent of patients), Ubrogepant (58.8 per cent ), Atogepant (23.5 per cent) and Zavegepant (5.9 per cent).
Researchers found that 76.5 per cent of patients reported relief of their most bothersome symptom after taking a gepant. 84.6 per cent said the medications helped 'quite a lot' in managing vestibular migraine symptoms. Relief often began within hours and, in many cases, lasted about 24 hours. 76.5 per cent of participants reported no side effects.
The authors caution that the study was small and retrospective, meaning it relied on patients' reports of their experiences rather than a controlled clinical trial. As a result, the findings cannot definitively establish effectiveness.
However, the results add to growing evidence that therapies targeting CGRP may have a role in treating vestibular migraine.
Larger, prospective studies will be needed to determine which patients benefit most, how these medications compare with existing treatments, and whether they should become a standard part of vestibular migraine care, say experts.
