Migraine Drugs Targeting CGRP Show Promise for Vestibular Migraine, Review Finds

Vestibular migraine, one of the most common causes of recurrent episodic vertigo, has long been managed with preventive drugs borrowed from headache medicine, yet their effects vary widely between patients. A new systematic review published in Frontiers in Neurology brings together the available evidence on how the condition is diagnosed and treated, and concludes that both conventional preventive therapies and a newer class of drugs targeting calcitonin gene-related peptide, or CGRP, can reduce the burden of dizziness and headache. The review, led by researchers from Security Forces Hospital, Princess Nourah bint Abdulrahman University and King Saud University Medical City in Riyadh, Saudi Arabia, also cautions that the evidence base for the newer agents remains limited.

The authors systematically searched the literature for studies assessing the diagnosis and pharmacological treatment of vestibular migraine. They included randomized controlled trials, observational and comparative studies, retrospective analyses, cross-sectional studies and case reports involving patients with definite or probable vestibular migraine as defined by established diagnostic criteria. Twenty-one studies met the inclusion criteria, covering a total of more than 12,000 participants.

The evidence came predominantly from adult populations, supplemented by one large pediatric multicenter study, and the adult participants were mainly middle-aged women, a pattern consistent with the known epidemiology of the condition. Diagnosis emerged as a central theme of the review. The Bárány Society and International Classification of Headache Disorders criteria served as the primary basis for diagnostic evaluation across the included studies.

On the treatment side, the review found that conventional preventive therapies were associated with reductions in vertigo frequency, headache burden and dizziness-related disability. The review examined five such agents: erenumab, fremanezumab, galcanezumab, rimegepant and ubrogepant. Across the included studies, these therapies were associated with clinically meaningful improvements in vertigo frequency, monthly dizziness days, disability scores, headache outcomes and patient-reported quality of life.

For a condition in which dizziness, not just headache, drives disability, improvements in vestibular-specific outcomes are particularly notable. The authors highlight that CGRP-targeted therapies represent a promising emerging option, especially for patients whose symptoms persist despite conventional preventive treatment. That evidence carries important limitations, which the authors state plainly.

The randomized evidence for CGRP-targeted therapies in vestibular migraine is limited, and there is a scarcity of direct head-to-head comparisons against conventional preventive therapies. As a result, the review concludes that firm statements about the comparative effectiveness of the two approaches cannot yet be made. For clinicians, the practical message of the review is twofold.

First, the multimodal diagnostic approach, combining Bárány Society and ICHD criteria with selective vestibular testing and neuroimaging to rule out alternatives, is supported by the current evidence. Second, both traditional preventive treatments and CGRP-targeted therapies have demonstrated benefit across vestibular and migraine-related outcomes, giving clinicians grounds to consider the newer agents in persistent or refractory cases while awaiting stronger comparative data. The drugs that have reshaped migraine prevention and acute treatment appear, on the available evidence, to help the vestibular symptoms that make vestibular migraine so disabling.

But the authors' own conclusion is the appropriate takeaway: promising, yes, yet pending the randomized trials and direct comparisons that would establish where CGRP-targeted therapy belongs in the treatment pathway relative to the older, cheaper and better-studied preventives.

Subject of Research: Diagnosis and pharmacological treatment of vestibular migraine, including conventional preventives and CGRP-targeted therapies

Article Title: Contemporary diagnosis and management of vestibular migraine: a systematic review of conventional and CGRP-targeted therapies

Article References: Alabood, S., Aldokhail, L., Alotaibi, E., Alsaqr, M., Alshehri, A., & Bakry, E. (2026). Contemporary Diagnosis and Management of Vestibular Migraine: A Systematic Review of Conventional and CGRP-Targeted therapies. Frontiers in Neurology, 17, 1951810. https://doi.org/10.3389/fneur.2026.1951810

Image Credits: AI Generated

DOI: 10.3389/fneur.2026.1951810

Keywords: vestibular migraine, CGRP, erenumab, fremanezumab, galcanezumab, rimegepant, ubrogepant, vertigo, systematic review, neuro-otology, preventive therapy, Bárány Society criteria