When Sarah Nguyen first felt the room spin out of control during a team meeting in San Francisco, she thought she was having a stroke. Instead, she was diagnosed with vestibular migraine—a condition that affects an estimated 1% of the global population and is the most common cause of recurrent spontaneous vertigo. For years, treatment options were limited, especially for stopping an acute attack. Now, a new study offers fresh hope: gepants, a class of oral and nasal migraine medications, may effectively relieve both dizziness and head pain in people with vestibular migraine. Published in Otolaryngology–Head and Neck Surgery, the research is already changing how doctors approach this often-misunderstood condition.
Vestibular migraine remains underdiagnosed, in part because its symptoms—spinning sensations, imbalance, nausea—overlap with other inner ear disorders. While some migraine preventives help, few options exist for halting an episode once it starts. Triptans, long the go-to for acute migraine, have shown little benefit for vertigo. But gepants work differently. By blocking calcitonin gene-related peptide (CGRP), a molecule deeply involved in migraine pathways, they target not just pain but also the balance centers of the brain and inner ear. "CGRP has emerged as a major factor in the pathogenesis of migraine," says Dr. Jeffrey D. Sharon, the study’s corresponding author and an otolaryngologist at the University of California, San Francisco. His earlier trial showed CGRP monoclonal antibodies outperformed placebo in treating vestibular migraine. This time, his team turned to gepants—smaller, easier-to-administer molecules that can be taken as pills or nasal sprays.
The study analyzed real-world use of four FDA-approved gepants: rimegepant, ubrogepant, atogepant, and zavegepant. Among the 34 patients studied, rimegepant was the most commonly used (88.2%), followed by ubrogepant (58.8%), atogepant (23.5%), and zavegepant (5.9%). Patients used the drugs either to stop acute attacks, prevent them daily, or both. Those who used gepants for both purposes reported a striking 100% benefit rate. Even among those using them only to abort attacks, more than 70%—71.4%, to be exact—felt relief. Most noticed improvement within hours, with effects lasting about a day. Crucially, 76.5% of patients reported no side effects, a promising sign for long-term use.
The findings are preliminary—based on a retrospective analysis with a small sample—but they’re compelling enough to shift clinical practice. For patients who avoid injections, the availability of oral and nasal options could be a game-changer. "We do think that it's reasonable to use gepants in the treatment of vestibular migraine," Dr. Sharon said, calling for larger, prospective trials to confirm the results. As research advances, one thing is clear: a new era of targeted, accessible treatment for vertigo may finally be within reach.