In 50 vestibular migraine patients treated with anti-CGRP monoclonal antibodies, 90% achieved at least 50% reduction in vertigo frequency and monthly dizziness days dropped from 10.3 to 0.8 over 12 months.
10.3 → 0.8 dizziness days/monthVestibular migraine patients went from over 10 days of dizziness per month to less than 1 day after 12 months of anti-CGRP antibody treatment
What the researchers found
Fifty vestibular migraine patients treated with anti-CGRP monoclonal antibodies (erenumab, fremanezumab, or galcanezumab) over 18 months:
- **Vertigo**: 45/50 patients (90%) achieved ≥50% reduction in vertigo frequency
- **Headache**: 43/50 patients (86%) achieved ≥50% reduction in headache frequency
- **Disability**: 40/50 patients (80%) had ≥50% reduction in MIDAS disability score
- **All three metrics**: 39/50 patients (78%) improved on vertigo, headache, AND disability simultaneously
- **Dizziness days**: Dropped from 10.3 ± 1.9 days/month at baseline to 0.8 ± 0.3 days/month at 12 months (difference 9.5 days, 95% CI 3.6-15.4, p<0.001)
Why it matters
Vestibular migraine affects millions but has no specifically approved treatment — patients often cycle through repurposed drugs with limited success. A 90% response rate for vertigo reduction is remarkable and could establish anti-CGRP antibodies as a game-changing treatment for this debilitating condition. The finding that CGRP is present in inner ear structures also provides a biological rationale for why these drugs work on vestibular symptoms.
How the study worked
This was a prospective observational cohort study of 50 vestibular migraine patients treated with one of three anti-CGRP monoclonal antibodies. Outcomes measured over 18 months included mean monthly headache days, dizziness/vestibular symptom days, pain intensity, and migraine-related disability (MIDAS score). Response was defined as ≥50% reduction in each parameter.
What this study cannot tell us
This was an observational study without a control group or placebo comparison, so the placebo effect cannot be ruled out. The sample size of 50 patients is modest. Three different anti-CGRP antibodies were used, making it difficult to compare individual drug efficacy. The patient population was from a single center. Randomized controlled trials are needed to confirm these promising results.
How to read the evidence
This is a prospective observational cohort study (no placebo control) in 50 human patients followed for 18 months. While the response rates are impressive and the study design is reasonable, it lacks randomization and blinding — the gold standard for treatment efficacy.
When this study was published
Published in 2023, this study is very current and contributes to the rapidly growing evidence base for anti-CGRP antibodies in vestibular migraine — a condition that is still finding its place in treatment guidelines.
The bigger picture
Anti-CGRP antibodies were developed for migraine headache prevention, but vestibular migraine has been largely excluded from pivotal trials. This study — alongside emerging case series — suggests these drugs address the vestibular component of migraine as well, likely because CGRP receptors in the inner ear contribute to vestibular symptoms. If confirmed in randomized trials, it would significantly expand the treatment population for anti-CGRP therapies.
Questions still open
- Will randomized controlled trials confirm these impressive response rates for anti-CGRP antibodies in vestibular migraine?
- Do the three anti-CGRP antibodies (erenumab, fremanezumab, galcanezumab) differ in their vestibular efficacy, or are they interchangeable?
- Could anti-CGRP antibodies be effective for other vestibular disorders beyond vestibular migraine, given CGRP's presence in inner ear structures?
Common questions
What is vestibular migraine and how is it different from regular migraine?
Are anti-CGRP antibodies approved for vestibular migraine?
Read the original research
Anti-calcitonin gene-related peptide monoclonal antibodies for the treatment of vestibular migraine: A prospective observational cohort study.
Cephalalgia : an international journal of headache, 43(4), 3331024231161809
Citation
Russo, Cinzia Valeria; Saccà, Francesco; Braca, Simone; Sansone, Mattia; Miele, Angelo; Stornaiuolo, Antonio; De Simone, Roberto. (2023). Anti-calcitonin gene-related peptide monoclonal antibodies for the treatment of vestibular migraine: A prospective observational cohort study.. Cephalalgia : an international journal of headache, 43(4), 3331024231161809. https://doi.org/10.1177/03331024231161809