Early Experience Treating Vestibular Migraine With Small Molecule CGRP Antagonists

OBJECTIVES: Blocking the activity of calcitonin gene-related peptide (CGRP) has emerged as a possible method for the prevention of vestibular migraine (VM). We aimed to investigate the effectiveness of small molecule CGRP antagonists (gepants) for the treatment of VM. STUDY DESIGN: Retrospective case series. SETTING: Tertiary academic center. METHODS: Adult patients diagnosed with VM who were treated with gepants were included. The gepants used included ubrogepant, rimegepant, atogepant, and zavegepant. A set of questionnaires was sent to patients including the Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI), Dizziness Handicap Inventory (DHI), a survey regarding the details of their VM, and a survey focused on their experience with gepants. RESULTS: A total of 17 patients with VM who used gepants were included. Median age was 54.1 (SD 9.3) and the majority were female (70.6%). Vertigo was the most bothersome symptoms for 47.1% of patients. The most common gepant used was rimegepant (88.2%) followed by ubrogepant (58.8%), atogepant (23.5%), and zavegepant (5.9%). Seven patients (41.2%) took gepants in an abortive fashion, 3 patients (17.6%) used them as a preventative medication and 7 patients (41.2%) tried them as both a preventative or abortive medication. The majority of patients (76.5%) experienced relief of their most bothersome symptom after taking a gepant and 84.6% of this cohort claimed these medications helped quite a lot to manage their symptoms of VM. No serious adverse events were observed. CONCLUSIONS: Gepants are well-tolerated by patients and are promising agents for the treatment of vestibular migraine.