Anti-calcitonin gene-related peptide monoclonal antibodies for the treatment of vestibular migraine: A prospective observational cohort study

Russo, Cinzia Valeria; Saccà, Francesco; Braca, Simone; Sansone, Mattia; Miele, A.; Stornaiuolo, Antonio; Simone, Roberto De

doi:10.1177/03331024231161809

Cited by 24 publications

(11 citation statements)

References 16 publications

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“…The clinical benefit was observed just after three months of treatment. No significant difference was found in efficacy between the three monoclonal antibodies [15]. The small sample size and the observational design without a control group make the evidence of low certainty.…”

Section: Medications Targeting the Cgrp Pathwaymentioning

confidence: 86%

Vestibular Migraine Therapy: Update and Recent Literature Review

Zanandrea,

Colombo,

Filippi

2023

Audiology Research

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Vestibular migraine (VM) is a neurological condition that causes vertigo and headache. It is considered the most common cause of episodic vertigo. However, specific treatments are missing, and medications currently used in VM are borrowed from migraine therapy. A comprehensive practical review of the literature assessing the evidence for abortive and preventive interventions in adults with VM was published in 2022, providing practical recommendations about VM treatment. The aim of our paper is to provide an updated overview of the current state of the art of VM treatment, illustrating new evidence available in this field. Along with traditional pharmacological preventive therapies, medications targeting the CGRP pathways have recently been investigated in terms of treatment effect in VM patients, with encouraging results. Also, there is new evidence of the efficacy of non-pharmacological interventions. However, the overall evidence base for VM treatment remains sparse.

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Section: Medications Targeting the Cgrp Pathwaymentioning

confidence: 86%

Vestibular Migraine Therapy: Update and Recent Literature Review

Zanandrea,

Colombo,

Filippi

2023

Audiology Research

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“…To the best of our knowledge, this was the first study that included instrumental analysis prior to and after mAb therapy in VM patients. Russo et al [ 32 ] performed a prospective observational cohort study in order to evaluate the efficacy of erenumab, fremanezumab, and galcanezumab for the treatment of 50 vestibular migraine patients. They found an excellent response to treatments, as 45 (90%) patients had at least a 50% reduction in vertigo frequency, and mean monthly days with dizziness/vestibular symptoms showed an overall significant decrease [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Monoclonal Antibodies Targeting CGRP: A Novel Treatment in Vestibular Migraine

Lovato,

Disco,

Frosolini

et al. 2023

Medicina

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Background. Monoclonal antibodies (mAbs) directed against the calcitonin gene-related peptide (CGRP) or its receptor represented the first targeted and specialized approach to migraine prophylaxis. Nevertheless, they have been rarely considered in the treatment of vestibular migraine (VM). Our aim was to evaluate the effectiveness of anti-CGRP mAbs in VM patients who did not respond to conventional migraine treatments. Methods. Consecutive VM patients treated with erenumab were considered. As a comparison, we considered the same VM patients during conventional migraine treatments (i.e., propranolol, flunarizine, or valproic acid), which were tried before mAbs therapy. Videonystagmography, the Italian version of the Dizziness Handicap Inventory (DHI) questionnaire, and migraine days over the last 3 months were evaluated in all patients before and after treatments. Results. In the present retrospective study, we included 21 female and 2 male VM patients, mean age 45.2 years. All patients underwent contrast-enhanced magnetic resonance imaging that ruled out other causes of vertigo. The DHI questionnaire significantly improved after mAb therapy (p < 0.0001). Mean migraine days over the last 3 months were significantly reduced after treatment (p = 0.001). Videonystagmography was altered in 11 (48%) patients prior to monoclonal antibodies. We found vertical positional nystagmus in 9 patients and horizontal positional nystagmus in 2 patients. After the treatment, we found vertical positional nystagmus only in 1 patient (p = 0.002). When patients were treated with conventional therapies, there was no significant reduction in DHI, and instrumental vestibular examinations remained altered. Conclusions. VM patients using anti-CGRP mAbs experienced a reduction in the dizziness-derived handicap, as reported in the DHI questionnaire. Furthermore, these treatments were significantly associated with a normalization of vestibular instrumental analysis. These findings were not seen with conventional treatments. Treatment with anti-CGRP mAbs may be effective in VM patients who did not respond to conventional migraine treatments. These findings should be tested in large, randomized clinical trials.

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“…vertigo, disequilibrium or both, response to a migraine preventive did not significantly differ in any of the groups [ 9 ], or that reduction of vertiginous symptoms is independent from presenting psychiatric comorbidities, as an amelioration in vertigo frequency or severity is not necessarily correlated with the improvement in anxiety or depression when comparing antidepressants with other preventives [ 109 ]. Patients with previous failure in several preventive treatments may also benefit from longer treatment with next-line prevention, such as medication targeting the CGRP pathway [ 110 , 111 ]. Populations with high proportion of aura had a good response to symptomatic treatment with flunarizine [ 112 ], and brainstem aura seems to respond to the similarly-structured drug, cinnarizine [ 113 ].…”

Section: Treatmentmentioning

confidence: 99%

Vestibular migraine: an update

Villar-Martinez,

Goadsby

2024

Current Opinion in Neurology

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Purpose of review We performed a narrative review of the recent findings in epidemiology, clinical presentation, mechanisms and treatment of vestibular migraine. Recent findings Vestibular migraine is an underdiagnosed condition that has a high prevalence among general, headache and neuro-otology clinics. Vestibular migraine has a bimodal presentation probably associated with a hormonal component in women. These patients could have a complex clinical phenotype including concomitant autonomic, inflammatory or connective tissue conditions that have a higher prevalence of psychological symptoms, which may mistakenly lead to a diagnosis of a functional neurological disorder. A high proportion of patients with postural perceptual persistent dizziness have a migraine phenotype. Independently of the clinical presentation and past medical history, patients with the vestibular migraine phenotype can respond to regular migraine preventive treatments, including those targeting the calcitonin gene-related peptide pathways. Summary Vestibular migraine is an underdiagnosed migraine phenotype that shares the pathophysiological mechanisms of migraine, with growing interest in recent years. A thorough anamnesis is essential to increase sensitivity in patients with unknown cause of dizziness and migraine treatment should be considered (see supplemental video-abstract).

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Anti-calcitonin gene-related peptide monoclonal antibodies for the treatment of vestibular migraine: A prospective observational cohort study

Cited by 24 publications

References 16 publications

Vestibular Migraine Therapy: Update and Recent Literature Review

Vestibular Migraine Therapy: Update and Recent Literature Review

Monoclonal Antibodies Targeting CGRP: A Novel Treatment in Vestibular Migraine

Vestibular migraine: an update

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