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

Medications for migraine prevention targeting the calcitonin gene-related peptide (CGRP) pathway have substantially reduced symptom burden in many patients that have failed previous treatment strategies. In contrast, data on treatment response to monoclonal antibodies (mAbs) or small molecule receptor antagonists (gepants) in patients suffering from vestibular migraine (VM) is scarce and preliminary.

CGRP-targeted therapies may be considered for vestibular migraine patients who have failed prior treatments, but the evidence base remains thin — audiologists and vestibular specialists should not yet treat this as a first-line, evidence-supported option and should defer prescribing decisions to neurologists.

As vestibular migraine is increasingly recognized as a major cause of chronic dizziness seen in audiology and vestibular clinics, establishing the evidence quality for emerging drug therapies directly informs interdisciplinary referral and co-management decisions.

1. 01CGRP-targeted therapies (e.g., monoclonal antibodies like erenumab) are being evaluated for vestibular migraine prevention and treatment.
2. 02The review focuses on patients who have failed conventional preventive therapies — a challenging clinical subgroup.
3. 03Overall evidence for CGRP therapies in vestibular migraine is assessed as limited, with few high-quality RCTs available.
4. 04Vestibular migraine is one of the most common causes of recurrent vertigo in adults.
5. 05Findings highlight a significant gap between clinical need and robust trial evidence in this space.

PMID

42396702

DOI

10.1111/ene.70688.

Journal

European Journal of Neurology

Publication type

review

Evidence level

1a

Population

Patients with vestibular migraine who have failed prior preventive treatment strategies

Intervention

CGRP-targeted therapies (e.g., anti-CGRP monoclonal antibodies, CGRP receptor antagonists)

Comparator

Placebo or standard/prior preventive treatments