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Scientific Oral Presentations

Otology/Neurotology

Session: Scientific Oral Presentation 4 - Otology/Neurotology

Early Experience Treating Vestibular Migraine with Small Molecule CGRP Antagonists

Sunday, October 12, 2025
1:48 PM - 1:54 PM EDT
Location: 244
Disclosure(s):
Evan J. Patel, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jeffrey D. Sharon, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Blocking the activity of calcitonin gene-related peptide (CGRP) has emerged as a promising method for the prevention of vestibular migraine (VM). We aimed to investigate the effectiveness of small molecule CGRP antagonists (gepants) for the treatment of VM.

Methods: A retrospective cohort study was conducted on all adult patients diagnosed with probable VM or VM by the Barany Society Criteria and who were treated with a small molecule CGRP antagonist. The gepants used included ubrogepant, rimegepant, atogepant, and zavegepant. A set of questionnaires was sent out to patients including the Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI), Dizziness Handicap Inventory (DHI), a survey regarding the details of their VM (eg. onset of symptoms, etc), and a survey focused on their experience with gepants.

Results: A total of nine patients with VM who used gepants were included. Mean age was 54.7 (SD 8.6) and the majority were female (66.7%). The most common gepant used was rimegepant (88.9%) followed by ubrogepant (55.6%), atogepant (22.2%) and zavegepant (11.1%). Four patients (44.4%) took gepants as both an abortive and preventative medication, three patients (33.3%) took them as an abortive treatment only and two patients (22.2%) took them as a preventative treatment only. Vertigo was the most bothersome symptoms for most patients (55.6%). The majority of patients (66.7%) experienced relief of their most bothersome symptom after taking a gepant and reported that overall these medications helped quite a lot to manage their symptoms of VM. No serious adverse events were observed.

Conclusions: Gepants can be effective medications for the treatment of vestibular migraine.

    Presenting Author(s)

  • EP

    Evan J. Patel, MD

    Resident Physician
    University of California - San Francisco
    San Francisco, CA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Kk

    Kali koziol, PA-C

    University of California - San Francisco, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Jeffrey D. Sharon, MD

    Associate Professor of Otolaryngology- Head and Neck Surgery
    UCSF Medical Center
    San Francisco, CA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.