Rizatriptan Not Effective for Acute Vestibular Migraine Relief

Results from a randomized clinical trial published in JAMA Neurology found that treatment with rizatriptan was ineffective for managing acute symptoms of vestibular migraine but was modestly effective at controlling headache-related symptoms at 24 hours. 

This double-blind study enrolled 222 adults diagnosed with vestibular migraine from 2 tertiary neurotologic centers. Participants were observed to confirm diagnosis and then randomized 2:1 to receive either rizatriptan 10 mg or placebo to treat up to 3 vestibular migraine attacks. In all, 134 participants treated 307 attacks using either rizatriptan or placebo. 

At 1 hour post-treatment, rizatriptan did not significantly outperform placebo in reducing vertigo (48.3% vs 56.8%; OR, 0.71; 95% CI, 0.42–1.21) or unsteadiness/dizziness (19.2% vs 12.4%; OR, 1.69; 95% CI, 0.80–3.57) symptoms. 

Secondary outcomes, including headache relief and associated migrainous symptoms, also showed no significant differences at this time point. 

At 24 hours, post hoc analyses indicated modest benefits of rizatriptan over placebo for unsteadiness/dizziness (OR, 2.65) and motion sensitivity (OR, 3.58). Additionally, improvements in headache and photophobia/phonophobia were observed. However, treatment satisfaction and quality of life measures were comparable between groups. No serious adverse events were reported.