ENT Manifestations of Migraine 27: Vestibular Migraine and Tinnitus response to CGRP Antibodies

Medication 💊 CGRP antagonists
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Well, this is interesting!

Ok so migraine response expected BUT:

Response from tinnitus to anti-CGRP drug!

I’m tempted to pursue this as tinnitus is my one remaining issue.

Very interested to hear from anyone whose tinnitus changed in response to this family of medication ! :thinking:

Short AI Video Summary

A young woman diagnosed with vestibular migraine experienced significant relief of symptoms, including migraines and associated dizziness, after switching to galcanezumab, a CGRP antibody. While she still faces mild tinnitus before her next dose, the patient’s positive response suggests the potential effectiveness of CGRP antibodies in managing complex symptoms of vestibular migraine and tinnitus.

Long AI Video Summary

A young lady previously diagnosed with vestibular migraine had undergone several unsuccessful medical treatments, including nortriptyline, topiramate, diltiazem, and xenismide. Due to these failures, she was shifted to galcanezumab, a CGRP antibody, which targets the CGRP ligand. The patient reported a significant improvement after taking galcanezumab for five months. She no longer experiences migraines or associated dizziness symptoms, with the only remaining issue being tinnitus in the days leading up to her next dose of the antibody. However, she has not experienced any major side effects from the treatment.

The patient experiences tinnitus in both ears, with the left ear being more affected. Despite having normal hearing, she continues to experience tinnitus without any ear fullness. Interestingly, the tinnitus subsides when she receives the next dose of the CGRP antibody before gradually returning towards the end of the dosing cycle. This unique response suggests a potential link between tinnitus and migraine activity, highlighting the effectiveness of CGRP antibodies in treating vestibular migraine and tinnitus symptoms.

The association between treatable tinnitus and migraine activities is significant, given the patient’s positive response to CGRP antibodies. This response is particularly noteworthy as it pertains to the relief of vestibular migraine symptoms and tinnitus, which has not been widely reported previously. The patient’s experience provides valuable insights into the potential efficacy of CGRP antibodies in managing complex symptoms associated with vestibular migraine and tinnitus, offering hope for those who have not responded to traditional treatment methods.

The promising results seen in this case underscore the importance of exploring alternative treatment options for vestibular migraine and associated symptoms such as tinnitus. While the patient still encounters mild tinnitus before the next dose of the antibody, the overall improvement in her condition after switching to galcanezumab highlights the potential of CGRP antibodies in addressing complex migraine manifestations. Further research and clinical trials may be warranted to validate these findings and potentially expand the use of CGRP antibodies in managing vestibular migraine and tinnitus more broadly.

The patient’s willingness to share her experience provides valuable insights into the management of vestibular migraine and tinnitus, shedding light on the potential benefits of CGRP antibodies in addressing these challenging conditions. This follow-up interview showcases the positive impact of personalized medicine and targeted therapies in improving patient outcomes, especially for individuals who have not responded to conventional treatment approaches. Moving forward, continued monitoring and research in this area could pave the way for more effective treatments for vestibular migraine and associated symptoms like tinnitus.

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I tried Aimovig but unfortunately it did absolutely nothing for any of my symptoms. I think it’s just like any other migraine treatment - works for some, not for others. It’s just another possible solution.

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My tinnitus pre-exists VM and is accompanied by high-frequency hearing loss and occasional sense of fullness/pressure. But wow! If this helped? And in the US, there is a pill available, so maybe no injection? It’s an expensive drug, though. I have sample doses of both Nurtec (rimegepant) and Ubrevly (ubrogepant) but have not taken either. My neurologist gave me them as treatment for an acute episode, which I don’t really get anymore. Nor do I know if a single dose would have any impact whatsoever on the tinnitus. I’m looking forward to more research coming out on this.

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Hi, my story sounds very similar to yours. I’ve had tinnitus since age 9-10 and VM diagnosed 6-7 years ago. I find this interesting, I’ll have to pay more attention when I take Nurtec to see if my tinnitus reduces. FYI - Nurtec isn’t good at abortive, even my neurologist came to the same conclusion (she has migraine). But if you mix Nurtec with a triptan (Maxalt), it’s life changing. Something with the combo prevents me from having the triptan hangover (brain fog). I don’t have any experience with Ubrevly. If you have commercial insurance in the US, Nurtec can be had for next to nothing with the coupon, I’m sure Ubrevly is the same way.

I’ve been on Aimovig, it helped but when my insurance changed to Emgaility, bingo much bigger difference in preventive migraine. Compared to the mess was 6-7 years ago, I’m a changed person with the new anti-CGRP meds. With those no change to the tinnitus.

Research, I’ve learned there are official studies but they take their time. My doc does her own “research”, as new meds come out, she gives them to patients with difficult to control migraine. Then during a follow up asks how it worked out. That’s how she learned Nurtec & Maxalt are a good abortive combo. The more we share our stories, more information gets out there that people can think about & use. It’s not scientific but all migraine suffers want to help each other because none of us want to suffer.

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Ubrelvy is more potent and fast-acting and not meant for continuous use like Nurtec is

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Thanks for your post. Can I check if Emgaility improved your vestibular migraine symptoms? i.e not just a painful head? I have VM for past 10 years have recently tried Aimovig without any luck and the NHS won’t allow you to trial another CGRP blocker.

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Hi, I would say Emgality has helped with dizziness. What a shame NHS doesn’t let try other anti-CGRP meds, yes they are the same class, but they attack the problem differently. That’s why I attribute Emgality working better for me than Aimovig. My doctor’s belief, don’t give up, try another because we’ll different & react differently to meds.

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Did you try it? Was it the pill?

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Nope, not yet. I need a break from work long enough to deal with potential side effects. But mostly, I just forgot about this as an option​:grimacing::joy:.

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