Rimegepant for vestibular and cochlear symptoms associated with vertigo in a real-world retrospective study

Vertigo commonly co-occurs with cochlear symptoms, yet evidence for calcitonin gene-related peptide (CGRP) receptor antagonists across audiovestibular disorders remains limited. We retrospectively evaluated 54 adults with vertigo who received rimegepant 75 mg daily or every other day for 8 weeks. Rimegepant use was associated with reductions in monthly vertigo and headache days, tinnitus severity, and psychological assessment scores, as well as improvements in pure-tone average and aural fullness. By week 8, 94.4% of patients achieved at least a 50% reduction in monthly vertigo days, and the median perceived onset of improvement was 6 days. In exploratory analysis, daily dosing was associated with a greater reduction in monthly vertigo days than alternate-day dosing. These findings provide preliminary real-world evidence supporting prospective controlled evaluation of CGRP-targeted therapy for vertigo-associated vestibular and cochlear symptoms.