Rizatriptan Ineffective for Vestibular Migraine Treatment, reveals study
Researchers have discovered in a new study that rizatriptan was ineffective at relieving vestibular migraine attacks within 1 hour and showed only limited symptom improvement at 24 hours. These results do not support the use of rizatriptan for treatment of vestibular migraines. The study was published in JAMA Network by Jeffrey P. and colleagues.
This double-blind, placebo-controlled randomized clinical trial was conducted in two tertiary neurotologic centers. 222 patients (mean age 42.3 years; 70.7% female) were originally enrolled. After prospective observation to establish diagnosis and illness activity over a period, 134 patients (60.4%) with active disease were randomized in a 2:1 ratio to receive either rizatriptan 10 mg or placebo. Each patient was asked to treat up to three discrete attacks of vestibular migraine.
The major results were whether rizatriptan was able to decrease vertigo and unsteadiness/dizziness from moderate or severe to absent or mild at 1 hour after taking medication. Secondary outcomes were total resolution of the symptoms, decrease in headache and related symptoms, rescue medication use, 24-hour symptom status, treatment satisfaction, and quality of life at 48 hours.
Key Findings
The last efficacy analysis comprised 240 attacks with vestibular symptoms rated moderate or severe at treatment.
At 1 hour, rizatriptan and placebo had no statistically significant differences in relief of symptoms:
Vertigo relief: 48.3% (73/151 attacks) with rizatriptan vs. 56.8% (50/88 attacks) with placebo (Odds Ratio [OR], 0.71; 95% CI, 0.42–1.21)
Relief of unsteadiness/dizziness: 19.2% (29/151) on rizatriptan vs. 12.4% (11/89) on placebo (OR, 1.69; 95% CI, 0.80–3.57)
Use of rescue medication at 1 hour: Same for both groups at 26.4%
Total relief of symptoms at 1 hour: Not different
At 24 hours, rizatriptan had modest advantages:
Unsteadiness/dizziness: OR 2.65 favoring rizatriptan
Motion sensitivity: OR 3.58 favoring rizatriptan
Medium effects on headache, photophobia, and phonophobia were found by post hoc analysis
But treatment satisfaction and overall quality of life measures were inconsistent, and there were no severe adverse effects or side effect discontinuations.
The usage of rizatriptan is not recommended for the management of vestibular migraine attack, particularly when immediate control of the symptoms is warranted. These results highlight the urgent necessity of the discovery of targeted vestibular migraine therapies since the disease still has no standardized treatment.
Reference:
Staab JP, Eggers SDZ, Jen JC, et al. Rizatriptan vs Placebo for Attacks of Vestibular Migraine: A Randomized Clinical Trial. JAMA Neurol. 2025;82(7):676–686. doi:10.1001/jamaneurol.2025.1006
