The efficacy of rimegepant for the acute treatment of vestibular migraine

INTRODUCTION: This study aimed to observe the efficacy and safety of rimegepant, a small-molecule calcitonin gene-related peptide (CGRP) receptor antagonist, for the acute treatment of vestibular migraine (VM). METHODS: Patients meeting the diagnostic criteria for VM or probable VM received rimegepant 75 mg for acute attacks. They rated the severity of five prominent VM symptoms (vertigo, unsteadiness or dizziness, nausea or vomiting, photophobia or phonophobia, and headache) on a 0-3 scale. Assessments were recorded at baseline, 30 min, 1 h, 2 h, 4 h, 24 h, and 48 h post-treatment. Efficacy outcomes included the percentage of patients with symptom recovery (from moderate/severe to absent/mild), moderate/severe symptoms, and freedom from symptoms at various time points. RESULTS: 18 VM patients were included. All symptom scores showed a decreasing trend from 30 min after rimegepant treatment. Scores for all symptoms except headache were significantly decreased at 2 h. The percentage of patients with moderate/severe symptoms decreased from 50.0% to 72.2% at baseline to 0% by 24 h for all symptoms. Moreover, freedom from all symptoms except unsteadiness/dizziness was achieved by 24 h. No adverse events were reported. CONCLUSION: We first demonstrate rimegepant 75 mg is safe and well-tolerated, which contributes a rapid relief of the prominent symptoms of VM including vertigo, unsteadiness or dizziness, nausea or vomiting, photophobia or phonophobia, and headache. Although required further validation, our findings may provide novel viewpoint on the treatment of VM.