Lasmiditan as a potential targeted therapy for vestibular migraine? A case study

Background Vestibular migraine (VM) is a common migraine subtype. Treatment options in the acute stage are limited. Case Here, we present the case of a 53-year-old woman experiencing frequent episodes of sensory aura, as well as vertigo and right-sided headaches lasting between 2 and 9 hours. The patient initially used rizatriptan as acute therapy, which reduced the headaches but not the vertigo. Only the use of lasmiditan led to a reduction in both the headache and the vertigo. Conclusion We hypothesize that in this patient, the vertigo was caused by vasoconstriction and that rizatriptan was unable to reverse this effect due to its selective binding to 5-HT1B receptors, which mediate vasoconstriction. As lasmiditan does not bind to 5-HT1B receptors, it should be evaluated as an option for the acute treatment of VM in larger cohorts.