The drug rizatriptan is often recommended for different types of migraines
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A medication commonly prescribed for migraines actually seems to do little to ease vestibular ones, which cause vertigo, along with more typical symptoms like headache and sensitivity to light. This is despite the drug, called rizatriptan, sometimes being recommended for these sorts of migraines.
Research on vestibular migraine treatment has been largely inconsistent, showing mixed results for a range of drugs, says Jeffrey Staab at the Mayo Clinic in Rochester, Minnesota. A few newer medications like galcanezumab might reduce how often such attacks occur, but, until now, no randomised trial had tested whether migraine drugs relieve vestibular symptoms during an episode itself.
To address that gap, Staab and his colleagues recruited 134 adults with vestibular migraine who were told to take either 10 milligrams of rizatriptan or a placebo at the onset of vestibular symptoms, such as balance problems or the sensation of spinning, during a total of 307 moderate-to-severe episodes. They then rated their symptoms on a scale from 0 to 3 at multiple points in time until the episode resolved.
One hour after taking the medication – when rizatriptan reaches its peak concentration in the bloodstream – it was no more effective than a placebo for relieving any symptoms, despite the drug often being credited for its fast action. People in both groups were also just as likely to turn to a backup medication after the required 1-hour wait.
After 24 hours, rizatriptan appeared to provide slightly better relief for sensitivity to motion, light and sound, but not for vertigo. Participants also reported marginally higher scores for physical well-being – such as their energy levels and ability to carry out daily tasks – compared with the placebo, but with no difference in mental well-being or side-effect acceptance.
Rizatriptan belongs to a class of drugs called triptans, which are generally effective for treating migraine headaches, but may not work for vestibular symptoms, says Staab.
The findings suggest that the brain pathways involved in vestibular migraines – the vestibular systems, which are “quite primitive” from an evolutionary perspective – lack sensitivity to triptans, for reasons yet to be explored, says Peter Goadsby at King’s College London. But vestibular migraines shouldn’t be classified as a separate condition from other migraines, he says, rather, their symptoms represent “small twists” in migraine pathology that warrant their own targeted treatment strategy.
“It says to fellow clinicians that you need to ask about these symptoms,” says Goadsby. “And if you treat someone with vestibular migraine – for example, with a triptan – you need to be prepared for it not to work, and to understand that this doesn’t mean the patient is being difficult or unreasonable.”
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