Rizatriptan for Vestibular Migraine
Trial question
What is the role of rizatriptan in patients with vestibular migraine?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
75.0% female
25.0% male
N = 134
134 patients (100 female, 34 male).
Inclusion criteria: adult patients, aged 18-65 years, with vestibular migraine.
Key exclusion criteria: uncompensated peripheral or central vestibular deficits; other causes of episodic vestibular symptoms; migraine with brainstem aura; illnesses that increase the risk for serious adverse effects from rizatriptan; medications incompatible with rizatriptan; previous use of rizatriptan for vestibular migraine; known adverse reactions to triptans.
Interventions
N=89 rizatriptan (at a dose of 10 mg).
N=45 placebo (matching placebo).
Primary outcome
Attacks with reductions in vertigo from moderate or severe to absent or mild at 1 hour
48.3%
56.8%
56.8 %
42.6 %
28.4 %
14.2 %
0.0 %
Rizatriptan
Placebo
No significant
difference ↔
No significant difference in attacks with reductions in vertigo from moderate or severe to absent or mild at 1 hour (48.3% vs. 56.8%; OR 0.69, 95% CI 0.33 to 1.46).
Secondary outcomes
No significant difference in attacks with reductions in unsteadiness/dizziness from moderate or severe to absent or mild at 1 hour (19.2% vs. 12.4%; OR 1.86, 95% CI 0.75 to 4.62).
No significant difference in complete relief of unsteadiness/dizziness at 1 hour (7.9% vs. 2.2%; OR 3.79, 95% CI 0.51 to 28.4).
Significantly greater reduction in unsteadiness/dizziness from moderate/severe to absent/mild without additional medication at 24 hours (82.6% vs. 66.1%; OR 2.65, 95% CI 1.04 to 6.79).
Safety outcomes
No significant differences in neurologic, chest, or abdominal adverse events.
Significant differences in mild or moderate fatigue at 48 hours (21.4% vs. 5.7%), mild or moderate sleepiness or drowsiness (24.9% vs. 9.4%).
Conclusion
In adult patients, aged 18-65 years, with vestibular migraine, rizatriptan was not superior to placebo with respect to attacks with reductions in vertigo from moderate or severe to absent or mild at 1 hour.
Reference
Jeffrey P Staab, Scott D Z Eggers, Joanna C Jen et al. Rizatriptan vs Placebo for Attacks of Vestibular Migraine: A Randomized Clinical Trial. JAMA Neurol. 2025 May 12:e251006. Online ahead of print.
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