Treatment response of calcitonin gene-related peptide monoclonal antibodies in vestibular migraine: a pilot study in a Korean population

Objectives: Vestibular migraine (VM) is a leading cause of recurrent vertigo, yet effective targeted treatments remain limited. Calcitonin gene-related peptide (CGRP) has been implicated in the pathophysiology of both migraine and vestibular disorders. This study investigates the therapeutic response of CGRP monoclonal antibodies (CGRP mAbs) in Korean patients with VM. Methods: We conducted a prospective observational study involving 24 Korean patients diagnosed with VM. Of these, 20 patients completed treatment and follow-up and were included in the final analysis. Nine patients received monthly galcanezumab and 11 received fremanezumab, both for a minimum of 2 months. The primary outcome measure was the change in Korean Dizziness Handicap Inventory (KDHI) score from baseline to the end of the treatment period. Secondary outcomes included monthly dizziness days (MDD), dizziness severity on a visual analog scale (VAS), patient-reported global impression of change (PGIC), and tolerability. Results: The average KDHI score decreased from 43.3 at baseline to 22.6 after treatment, with 75% of patients reporting much or very much improvement on PGIC. MDD dropped from an average of 20.8 to 6.65 days, and VAS dizziness severity declined from 7.2 to 3.8. Improvements were observed across KDHI subdomains. Both treatment groups showed benefit, and no serious adverse events were reported. Conclusion: CGRP mAbs therapy with galcanezumab or fremanezumab may significantly reduce vestibular symptoms and disability in Korean patients with VM. These findings support the potential role of CGRP mAbs in treating VM, particularly in populations underrepresented in previous studies.