The standard medications prescribed for migraines provide limited relief for the vestibular symptoms, which include dizziness and typical migraine manifestations like headaches and light sensitivity. This is true even for rizatriptan, which is sometimes recommended for such types of migraines.

Research on vestibular migraine treatment has been inconsistent, yielding mixed results across different medications, according to Jeffrey Staab from the Mayo Clinic in Rochester, Minnesota. Some newer medications, like galcanezumab, may reduce the frequency of attacks, but no randomized trials have previously evaluated the effectiveness of migraine medications in alleviating vestibular symptoms during episodes.

To fill this research gap, Staab and his team investigated vestibular migraines. Participants were instructed to take 10 milligrams of rizatriptan or a placebo at the onset of vestibular symptoms, such as balance problems and spinning sensations. Their symptoms were subsequently evaluated on a scale of 0 to 3 at several intervals until the episodes resolved.

One hour after administration—at which point rizatriptan reaches peak concentrations in the bloodstream—it was not more effective than the placebo in relieving symptoms which are often considered to act quickly. Both groups were allowed to use back-up medications after waiting the necessary hour.

After 24 hours, rizatriptan showed a slight improvement in sensitivity to movement, light, and sound, but not in dizziness. Participants also reported marginally higher scores concerning physical well-being—such as energy levels and the ability to carry out daily activities—when compared to those taking the placebo. However, no differences were noted in mental well-being or the acceptance of side effects.

Rizatriptan falls under the triptans class of drugs, typically effective against migraines, but may not alleviate vestibular symptoms, as noted by Staab.

The study’s findings indicate that the brain pathways linked to vestibular migraines (the vestibular system, which is considered “primitive” from an evolutionary standpoint) may lack sensitivity to triptans for reasons that are yet to be explored. According to Peter Goadsby from King’s College London, vestibular migraines should not be treated as distinct conditions from other migraine types; rather, their symptoms represent a “slight variation” of migraine pathology that necessitates targeted treatment approaches.

“I think it’s important to communicate with fellow clinicians about these symptoms,” Goadsby states. “For instance, if you are treating someone with a vestibular migraine using a triptan, be prepared for it to potentially be ineffective. It’s crucial to recognize that this doesn’t imply the patient is difficult or unreasonable.”