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Interest in CGRP-targeted treatment for vestibular migraine has grown rapidly, but the evidence base is still smaller than for conventional migraine. This 2024 rapid systematic review and meta-analysis examined studies of CGRP monoclonal antibodies in vestibular migraine. Across the available literature, treatment was associated with improvement in dizziness-related outcomes, vertigo frequency and migraine burden. The authors also emphasised important limitations: most studies were observational, sample sizes were small, outcome measures were heterogeneous and controlled evidence was scarce. These limitations mean that the direction of benefit is encouraging, but the size and durability of treatment effect remain uncertain. For HCPs, the paper supports considering CGRP-directed therapy in selected patients while maintaining realistic expectations about the current evidence. It is particularly useful for clinicians managing patients who have both migraine and prominent vestibular symptoms, because standard migraine evidence cannot simply be extrapolated without qualification. The review also reinforces the need for prospective, blinded trials with consistent diagnostic criteria and validated vestibular outcomes. In practice, diagnosis, trigger management, vestibular rehabilitation and conventional migraine prevention remain important parts of a comprehensive strategy.
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Interest in CGRP-targeted treatment for vestibular migraine has grown rapidly, but the evidence base is still smaller than for conventional migraine. This 2024 rapid systematic review and meta-analysis examined studies of CGRP monoclonal antibodies in vestibular migraine. Across the available literature, treatment was associated with improvement in dizziness-related outcomes, vertigo frequency and migraine burden. The authors also emphasised important limitations: most studies were observational, sample sizes were small, outcome measures were heterogeneous and controlled evidence was scarce. These limitations mean that the direction of benefit is encouraging, but the size and durability of treatment effect remain uncertain. For HCPs, the paper supports considering CGRP-directed therapy in selected patients while maintaining realistic expectations about the current evidence. It is particularly useful for clinicians managing patients who have both migraine and prominent vestibular symptoms, because standard migraine evidence cannot simply be extrapolated without qualification. The review also reinforces the need for prospective, blinded trials with consistent diagnostic criteria and validated vestibular outcomes. In practice, diagnosis, trigger management, vestibular rehabilitation and conventional migraine prevention remain important parts of a comprehensive strategy.
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