A multi-site randomized clinical trial found that rizatriptan, a commonly used migraine medication, may not significantly reduce vertigo or dizziness within 1 hour of onset during vestibular migraine attacks. The drug showed no advantage over placebo for rapid symptom relief.
Researchers enrolled 222 adults between 2014 and 2020 to evaluate whether a single 10-mg dose of rizatriptan could improve symptoms of vestibular migraine, a condition that affects up to 2.7% of the population and is a common cause of episodic vertigo.
Among the participants, 134 met diagnostic criteria and entered the treatment phase, during which they recorded 307 vestibular migraine attacks. The researchers noted that 240 of the attacks met protocol criteria for evaluating primary outcomes—specifically, whether vertigo or unsteadiness/dizziness improved from moderate or severe to absent or mild 1 hour after receiving the drug.
At the 1-hour mark, vertigo improved in 48.3% of rizatriptan-treated attacks compared with 56.8% of placebo-treated attacks. Unsteadiness or dizziness improved in 19.2% of rizatriptan-treated attacks versus 12.4% of placebo-treated attacks. These differences were not statistically significant.
“Rizatriptan was ineffective at 1 hour for treating vestibular migraine attacks and had limited benefit on symptoms at 24 hours. Findings do not support using rizatriptan for vestibular migraine attacks,” said lead study author Jeffrey P. Staab, MD, of the Mayo Clinic.
At 24 hours, rizatriptan showed medium-sized effects compared with placebo in reducing unsteadiness/dizziness (OR = 2.65) and motion sensitivity (OR = 3.58). Smaller improvements were also observed in headache and sensitivity to light or sound, although vertigo did not significantly improve at 24 hours.
Post hoc analyses of all 307 treated attacks supported the findings, showing moderate benefits for headache, photophobia/phonophobia, and motion sensitivity at 24 hours. Despite these later effects, the researchers noted that 1-hour outcomes are the primary measure of efficacy for acute migraine treatments.
Participants taking rizatriptan reported higher rates of minor side effects such as fatigue (21.4% vs 5.7%) and drowsiness (24.9% vs 9.4%) compared with those receiving placebo.
At 48 hours, treatment satisfaction and physical quality-of-life scores modestly favored rizatriptan, though mental well-being scores showed no statistically significant difference between groups.
The findings suggest a need for further research into effective acute treatments for this condition.
Full author disclosures can be found in the published study.
Source: JAMA Neurology
