Monoclonal antibodies targeting CGRP to treat vestibular migraine: a rapid systematic review and meta-analysis

Vestibular migraine (VM), a subtype of migraine characterized by vestibular symptoms, poses a significant diagnostic and therapeutic challenge. This study aimed to evaluate the effectiveness of monoclonal antibodies targeting Calcitonin Gene Related Peptide (CGRP) in the treatment of VM. Therefore, we conducted a rapid systematic review and meta-analysis following PRISMA and Cochrane guidelines. A search of databases (PubMed, Scopus, Cochrane and Google Scholar) was performed in October 2023. Inclusion criteria required original research articles focusing on patients diagnosed with VM and utilizing CGRP-targeting monoclonal antibodies. We performed qualitative assessments of study design, patient characteristics, and outcomes and, for studies with comparable outcome measures, a meta-analysis was conducted. Our search yielded four relevant studies, including cohort studies and a case report, totaling 99 patients. Proper vestibular instrumental tests were employed in half of the studies. Overall, the included studies reported significant improvements in VM symptoms. Our quantitative analysis, focused on migraine symptoms, demonstrated a substantial reduction in Monthly Days with Migraine at 6 months following treatment. No severe adverse drug reactions were reported. In conclusion, this rapid systematic review and meta-analysis provide preliminary evidence for the efficacy of CGRP-targeting monoclonal antibodies in treating Vestibular Migraine. However, the absence of randomized controlled trials and variations in study designs and diagnostic criteria introduce some limitations. Further research is needed, including controlled trials, to establish a more robust evidence base. Nonetheless, this treatment approach offers hope for the effective management of VM, potentially enhancing the well-being of affected individuals and reducing their associated disability.Novel Therapeutic Strategy: Monoclonal antibodies targeting CGRP offer a promising new treatment avenue for Vestibular Migraine.Significant Symptom Improvement: Patients administered with these antibodies exhibited notable reductions in the frequency and severity of symptoms.Migraine-related Disability: There's a marked decrease in migraine-related disability among patients treated with monoclonal antibodies against CGRP.Research Gaps Identified: Despite the promising results, there's a lack of randomized controlled trials and a considerable heterogeneity among existing studies.Call for Further Research: High-quality, randomized controlled trials are urgently needed to solidify the role of these antibodies in clinical management of Vestibular Migraine.