Rizatriptan not supported for treating vestibular migraine

Rizatriptan does not appear to be efficacious in the treatment of vestibular migraine attacks, showing no clear beneficial effects on any symptoms and on vertigo in a randomized clinical trial.

Two hundred and twenty-two adults patients (mean age 42.3 years, 70.7 percent women) with vestibular migraine were randomly assigned to treatment with rizatriptan 10 mg or placebo. The study drugs were used to treat up to three vestibular migraine attacks per participant.

The primary efficacy outcomes were the percentage of treated attacks with (1) vertigo or (2) unsteadiness or dizziness reduced from moderate or severe to absent or mild at 1 h. Other outcomes included the percentage of attacks with complete resolution of vestibular symptoms at 1 h; reductions in headache and associated symptoms at 1 h; use of rescue medications after 1 h; reductions in vestibular, headache, and associated symptoms at 24 h without rescue medications; treatment satisfaction and quality of life at 48 h; and rates of serious adverse effects and discontinuation due to adverse effects.

A total of 307 treated attacks were documented among 134 (60.4 percent) patients, with efficacy analysis including 240 attacks. At 1 h, rizatriptan treatment did not result in significant reductions in vertigo (48.3 percent vs 56.8 percent attacks; odds ratio [OR], 0.71, 95 percent confidence interval [CI], 0.42–1.21), unsteadiness/dizziness (19.2 percent vs 12.4 percent attacks; OR, 1.69, 95 percent CI, 0.80–3.57) compared with placebo.

The same was true for any secondary endpoints. Rizatriptan did not differ significantly from placebo in terms of the percentage of patients who took rescue remedies after 1 h (26.4 percent for both). At 24 h, rizatriptan had medium effects compared with placebo for unsteadiness/dizziness (OR, 2.65) and motion sensitivity (OR, 3.58).

Post hoc analyses of all treated attacks indicated a medium effect in favour of rizatriptan vs placebo for headache and photophobia or phonophobia at 24 h.

Treatment satisfaction was equivocal, and quality of life was mixed. None of the patients had serious adverse effects or discontinued treatment due to adverse effects.