CGRP-Targeting Therapies in Vestibular Migraine: A Synthesis of Observational Evidence with Direction-of-Effect Analysis

Vestibular migraine (VM) is a common but underdiagnosed cause of episodic vertigo lacking evidence-based preventive treatments. Calcitonin gene-related peptide (CGRP) plays a central role in migraine pathogenesis and is expressed in vestibular structures, providing a rationale for CGRP-targeting therapies in VM. However, available evidence has not been systematically synthesized.

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CGRP-targeting therapies show a consistent direction of benefit across observational studies for vestibular migraine prevention, but the evidence remains observational; clinicians may consider these agents for refractory cases while awaiting RCT data.

Vestibular migraine is one of the most common causes of episodic dizziness seen in audiology and neurotology clinics, and there are currently no FDA-approved preventive treatments specifically for it — making any emerging evidence highly relevant.

1. 01Synthesis of observational studies on CGRP-targeting drugs (e.g., erenumab, fremanezumab) for vestibular migraine prevention.
2. 02Direction-of-effect analysis used to assess consistency of findings across heterogeneous studies.
3. 03No randomised controlled trials were available; evidence is entirely observational.
4. 04Results suggest a consistent beneficial direction but formal efficacy cannot be confirmed without RCTs.
5. 05Vestibular migraine currently lacks any FDA-approved preventive pharmacotherapy.

PMID

42346827

DOI

10.3390/medsci14020288.

Journal

Medical Sciences

Publication type

review

Evidence level

2a

Population

Patients with vestibular migraine receiving CGRP-targeting therapies

Intervention

CGRP-targeting therapies (e.g., monoclonal antibodies targeting CGRP or its receptor) as preventive treatment