For Immediate Release
Contact: [email protected]
June 15, 2026, Alexandria, Virginia—A new study finds that a class of oral and intranasal medications known as gepants may be an effective and well-tolerated treatment for vestibular migraine (VM).
Vestibular migraine is the most common cause of recurring spontaneous vertigo and can be profoundly disruptive to daily life, yet it remains underdiagnosed and undertreated. While many medications used for standard migraine headache are also prescribed for VM, options for stopping an acute vestibular attack remain limited. Clinical trials of triptans—among the most widely used abortive migraine medications—have not demonstrated effectiveness specifically for vestibular symptoms.
Gepants work by blocking calcitonin gene-related peptide (CGRP), a molecule known to drive migraine attacks. CGRP has also been identified throughout the central and peripheral vestibular system—the brain structures responsible for balance—providing a biological rationale for why blocking it may relieve dizziness and vertigo, not just head pain. Unlike injectable CGRP monoclonal antibodies, gepants can be taken as a pill or nasal spray, making them an accessible option for patients who are averse to injections.
“CGRP has emerged as a major factor in the pathogenesis of migraine. Our previous work showed in a randomized clinical trial that CGRP monoclonal antibodies were more effective than placebo in treating vestibular migraine. This current study looked at gepants in a retrospective fashion and found that a significant percentage of patients with vestibular migraine thought they were helpful. The next step is to follow up these findings in a larger prospective study. In the meanwhile, we do think that it’s reasonable to use gepants in the treatment of vestibular migraine,” said Jeffrey D. Sharon, MD, corresponding author with the Department of Otolaryngology–Head & Neck Surgery, at the University of California, San Francisco, and author of The Great Balancing Act, An Insider’s Guide to the Human Vestibular System.
In this study, the most commonly used gepant was rimegepant (88.2% of patients), followed by ubrogepant (58.8%), atogepant (23.5%), and zavegepant (5.9%). Patients used gepants both to abort acute attacks and as daily preventive therapy. Those who used them for both purposes saw the highest benefit rates (100%), while abortive-only users reported benefit in 71.4% of cases. Most patients reported onset of relief within hours and symptom improvement lasting approximately 24 hours. The majority of patients (76.5%) reported no side effects.
Study Citation: Patel EJ, Koziol K, Sharon JD. “Early Experience Treating Vestibular Migraine With Small Molecule CGRP Antagonists.” Otolaryngology–Head and Neck Surgery. 2026. DOI: 10.1002/ohn.70196
Otolaryngology–Head and Neck Surgery
Otolaryngology–Head and Neck Surgery (OTO Journal) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. Our mission is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.
About the AAO-HNS/F
The AAO-HNS/F is one of the world’s largest organizations representing specialists who treat the ears, nose, throat, and related structures of the head and neck. Otolaryngologist-head and neck surgeons diagnose and treat medical disorders that are among the most common affecting patients of all ages in the United States and around the world. Those medical conditions include chronic ear disease, hearing and balance disorders, hearing loss, sinusitis, snoring and sleep apnea, allergies, swallowing disorders, nosebleeds, hoarseness, dizziness, and tumors of the head and neck as well as aesthetic and reconstructive surgery and intricate micro-surgical procedures of the head and neck. The Academy has approximately 13,000 members. The AAO-HNS Foundation works to advance the art, science, and ethical practice of otolaryngology-head and neck surgery through education, research, and quality measurement.
