xRead - Episodic Vertigo (January 2026)

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HEADACHE

analysis had VM. This distribution is different from other VM studies from our center, in which the distribution was closer to even between VM and probable VM, and may reflect differences in the population re ferred for clinical trials. 17 The average baseline VM-PATHI score in this trial was very similar to average scores seen during the development of VM-PATHI, suggesting similar disease severity. Thirty-seven percent of potentially eligible participants were excluded based on secondary vestibular diagnoses. While this may seem high, VM is clearly related to many other vestibulopathies, and further study of CGRP-blocking antibodies in this population is warranted. 7 There were several limitations of this study. The first is that it was unexpectedly concluded early when the sponsor stopped supplying galcanezumab and placebo while two participants were in the baseline period, and one participant had already been treated. A second limita tion is that due to an error from the study pharmacist, two participants were accidentally crossed over from placebo to galcanezumab arms. Furthermore, this is a small-scale, single-center study. We also did not systematically obtain pre- and post-intervention vestibular testing, which would have been interesting in exploring the mechanism of ac tion of CGRP in VM. Despite these limitations, the data clearly show a beneficial effect for CGRP blockade in VM; however, larger, multi center trials are required to further investigate these findings. This study also had several strengths. First, it was a double-blind, placebo-controlled trial, which is necessary for vestibular trials, which have consistently shown high rates of placebo response. 31 Second, data were collected daily during the study with a text mes saging system, and response rates were quite high. Third, outcomes were assessed with several methods, including count of DDDs, and patient-reported outcome measures (PROMs), including the widely used DHI, which is a symptom-specific PROM, and the newly devel oped VM-PATHI, which is a VM disease-specific PROM, and a gen eralized impression of change scale, and results were in accordance across all those metrics. In conclusion, treatment of VM with galcanezumab improved the count of DDDs, dizziness handicap, and VM disease severity com pared to placebo. AUTHOR CONTRIBUTIONS Jeffrey D. Sharon: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project adminis tration; resources; software; supervision; validation; visualization; writing – original draft. Roseanne Krauter: Methodology; project administration; supervision. Ricky Chae: Investigation; project ad ministration; resources; software. Adam Gardi: Investigation; meth odology; project administration; resources; software. Maxwell Hum: Investigation; methodology; resources. Isabel Allen: methodology, data analysis, supervision. Morris Levin: Investigation; methodol ogy; project administration; resources. ACKNOWLEDGMENTS We would like to thank all three members of the Data Safety Monitoring Board, including Dr. John Carey (Department of Otolaryngology-­ Head and Neck Surgery, Johns Hopkins School of Medicine),

Dr. Kristen Steenerson (Department of Otolaryngology-Head and Neck Surgery, Stanford University), and Dr. Kevin Delucchi (Department of Psychiatry, University of California, San Francisco). CONFLICT OF INTEREST STATEMENT Jeffrey D. Sharon received research support for this study from Eli Lilly. In addition, he has received research funding from Advanced Bionics. He is on the medical advisory board for Otolith Labs, and serves as the senior VP of clinical science at Spiral Therapeutics. Roseanne Krauter, Ricky Chae, Adam Gardi, Maxwell Hum, Isabel Allen, and Morris Levin have no conflicts to disclose.

ORCID Jeffrey D. Sharon

https://orcid.org/0000-0003-4892-5064

https://orcid.org/0000-0001-5014-9303

Ricky Chae

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