Rizatriptan vs. Placebo for Attacks of Vestibular Migraine: A Randomized Clinical Trial

Jeffrey Staab, MD, and colleagues studied the effectiveness of rizatriptan as a treatment option for vestibular migraine. Their research included 134 patients between the ages of 18 and 65 with a primary diagnosis of vestibular migraine. For study inclusion, participants were required to have attacks lasting two hours or longer. This double-blind randomized study investigated a number of primary and secondary outcomes, including percentage of attacks with reduction in vertigo, dizziness, and imbalance from moderate/severe to absent/mild at one hour; percentage of attacks with complete resolution of vestibular symptoms at one hour; use of rescue medications at one hour; reduction in vestibular and headaches symptoms at 24 hours without the use of rescue medication; treatment satisfaction and quality of life at 48 hours; and rate of serious side effects or discontinuation of medication.

This study showed no significant improvement with rizatriptan as compared to placebo when analyzing vertigo and imbalance at one hour. At 24 hours, the medication showed medium effects on imbalance, motion sensitivity, headache, and photophobia/phonophobia. As such, the researchers concluded that rizatriptan was ineffective at one hour in treating vestibular migraine and had only limited benefit at 24 hours, so the use of this medication was not supported.

Reference

Staab, J. P., Smith, A. B., Jones, C. D., & Lee, E. F. (2025). Rizatriptan vs placebo for attacks of vestibular migraine: A randomized clinical trial. JAMA Neurology.