A small new study has found that a class of migraine medications known as Gepant may provide significant relief for people with vestibular migraine (VM), a condition characterized by attacks of dizziness, vertigo, and balance disturbances.
The findings, published in a study titled “Early Experience in 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 treat acute vestibular symptoms and long-term disease management.
What is vestibular migraine?
Vestibular migraine is the most common cause of recurrent spontaneous vertigo. Patients can experience debilitating attacks of dizziness, imbalance, motion sensitivity, and vertigo, often with or without the severe headaches typically associated with migraines.
Despite its prevalence, the condition remains underdiagnosed and undertreated. While many of the medications used to treat traditional migraines are also prescribed to treat vestibular migraines, effective treatments to stop acute vestibular attacks have been limited.
Previous clinical trials of triptans, which are widely used to treat migraines, have not consistently demonstrated a benefit for vestibular symptoms, doctors say, and that is a gap the drugs may help fill.
Gipant is 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.
The researchers note that CGRP is also found throughout the body’s vestibular system, helping to regulate balance and spatial orientation. This biological connection has led scientists to investigate whether blocking CGRP could relieve dizziness and vertigo as well as migraine pain.
Unlike injectable CGRP-targeting monoclonal antibodies, the drugs are available in the form of oral tablets or nasal sprays, making them more convenient for many patients.
Sharon from the University of California, San Francisco: “CGRP has emerged as a major factor in the pathogenesis of migraines. Our previous work showed in a randomized clinical trial that CGRP monoclonal antibodies were more effective than placebo in treating vestibular migraines. This current study looked at the genes in a retrospective manner and found that a significant proportion of patients with vestibular migraines thought they were helpful.”
He added that larger prospective studies are needed, but current evidence suggests that it is reasonable to consider Gepant as a treatment option for vestibular migraine.
The study included 17 adults diagnosed with vestibular migraine who were treated with one or more gepants. The average age of participants was 54 years, and about 71 percent of them were women. Nearly half reported dizziness as their most bothersome symptom. Medications used included rimgepant (88.2% of patients), aprogepant (58.8%), atogepant (23.5%), and zavigepant (5.9%).
The researchers found that 76.5% of patients reported improvement in their most bothersome symptoms after taking Gepant. 84.6% said medications helped “a lot” in managing vestibular migraine symptoms. Relief often begins within hours and, in many cases, lasts about 24 hours. 76.5 percent 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 controlled clinical trials. As a result, results cannot conclusively prove effectiveness.
However, the findings add to growing evidence that therapies targeting CGRP may have a role in treating vestibular migraine.
Experts say larger future studies are needed to determine which patients benefit most, how these drugs compare with current treatments, and whether they should become a standard part of vestibular migraine care.
