SynthesisMedical sciences (Basel, Switzerland)2026
CGRP-Targeting Therapies in Vestibular Migraine: A Synthesis of Observational Evidence with Direction-of-Effect Analysis.
Synthesis in Medical sciences (Basel, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
14 authors.
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Abstract
backgroundVestibular migraine (VM) is a common but underdiagnosed cause of episodic vertigo lacking evidence-based preventive treatments. Calcitonin gene-related peptide (CGRP) plays a central role in migraine pathogenesis and is expressed in vestibular structures, providing a rationale for CGRP-targeting therapies in VM. However, available evidence has not been systematically synthesized.
methodsWe conducted a structured synthesis of studies evaluating CGRP-targeting therapies (monoclonal antibodies and gepants) in adults with definite/probable VM. We searched PubMed/MEDLINE, Embase, Scopus, and Web of Science. Eligible studies included randomized controlled trials, prospective/retrospective cohorts, and case series (≥10 patients) reporting quantitative outcomes. A two-tier synthesis was prespecified: quantitative meta-analysis where feasible, otherwise narrative synthesis with direction-of-effect analysis.
resultsOf 247 records, four observational studies met inclusion criteria (total N ≈ 103 patients). No RCTs were identified. All four studies evaluated CGRP monoclonal antibodies; no gepant studies met inclusion criteria. Outcome reporting was highly heterogeneous. Quantitative meta-analysis was not feasible. Direction-of-effect synthesis showed consistent improvement across all studies for vertigo frequency (4/4), Dizziness Handicap Inventory (2/2), and monthly migraine days (2/2). No serious adverse events were reported.
conclusionsCGRP monoclonal antibodies show a consistent direction of benefit for vestibular symptoms, migraine days, and dizziness handicap in observational VM studies, with a favorable safety profile. However, the absence of RCTs, small samples, lack of control groups, and heterogeneity preclude definitive conclusions. This synthesis highlights a critical evidence gap. Adequately powered, double-blind, placebo-controlled RCTs of CGRP-targeting therapies (both monoclonal antibodies and gepants) are urgently needed.
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