Rizatriptan Ineffective Compared to Placebo in Early Treatment of Vestibular Migraine

A comprehensive randomized clinical trial conducted by researchers at UCLA and Mayo Clinic has found that rizatriptan does not provide significant benefit over placebo in alleviating acute symptoms of vestibular migraine within the first hour of treatment. Vestibular migraine, characterized by intense vertigo, affects approximately 2.7% of the population and often leads patients to seek migraine-specific medications, such as triptans, despite limited strong clinical evidence supporting their use for this condition.

In the study titled "Rizatriptan vs. Placebo for Attacks of Vestibular Migraine," published in JAMA Neurology, participants from two leading neurologic centers were enrolled to evaluate the drug’s efficacy. All participants met strict diagnostic criteria for vestibular migraine, with 222 adults enrolled and 134 with active symptoms moving into the treatment phase. Over 204 migraine attacks were assessed under rigorous protocols.

Participants were randomly assigned in a 2:1 ratio to receive either 10 mg of rizatriptan or a placebo at the onset of moderate to severe vestibular symptoms. The primary outcome measured was the reduction of vertigo or dizziness from moderate/severe to absent/mild within one hour of medication intake. Results showed that rizatriptan did not outperform placebo; approximately 48.3% of attacks treated with rizatriptan improved, compared to 56.8% in the placebo group—a difference that was not statistically significant. Similar findings were observed for other symptoms such as headache and nausea.

The medication was well tolerated, with no serious adverse events reported. Slightly higher occurrences of fatigue and drowsiness were noted in the rizatriptan group, consistent with known side effects. Overall, medication usage rates did not differ between groups.

Based on these findings, the researchers concluded that rizatriptan does not offer meaningful relief for vestibular migraine symptoms within the first hour of attack. The results question the routine use of triptans in this context, emphasizing the need for further research to identify more effective treatment options.

For more detailed information, refer to the original publication: Jeffrey P. Staab et al, Rizatriptan vs Placebo for Attacks of Vestibular Migraine, JAMA Neurology (2025). Source: https://medicalxpress.com/news/2025-05-rizatriptan-advantage-placebo-hour-vestibular.html