JAMA Neurol

Rizatriptan showed limited efficacy in vestibular migraine treatment

May 15, 2025

Study details: This double-blind, randomized trial included 222 adults with vestibular migraine from two tertiary neurotologic centers. Participants were randomized in a 2:1 ratio to receive either rizatriptan 10 mg or placebo for up to three vestibular migraine attacks. Symptoms were rated at scheduled intervals, focusing on reductions in vertigo and unsteadiness/dizziness from moderate or severe to absent or mild at one hour.

Results: No significant difference was found between rizatriptan and placebo in reducing vertigo (48.3% vs. 56.8%, odds ratio [OR], 0.71; 95% confidence interval [CI], 0.42-1.21) or unsteadiness/dizziness (19.2% vs. 12.4%, OR, 1.69; 95% CI, 0.80-3.57) at one hour. Secondary outcomes, including headache relief and use of rescue medications, also showed no significant differences. At 24 hours, rizatriptan had medium effects over placebo for unsteadiness/dizziness (OR, 2.65) and motion sensitivity (OR, 3.58). No serious adverse effects were reported.

Clinical impact: While rizatriptan showed some benefits at 24 hours, its lack of significant efficacy at one hour suggests limited utility for immediate symptom relief in vestibular migraine. Consider these findings when prescribing treatments and explore alternative therapies for rapid symptom management.

Source:

Staab JP, et al. (2025, May 12). JAMA Neurol. Rizatriptan vs. Placebo for Attacks of Vestibular Migraine: A Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/40354049/