Prevention of motion sickness with rizatriptan: a double-blind, placebo-controlled pilot study

Serotonergic triptan medications effectively reverse pain and associated symptoms of migraine. Vestibular symptoms, including dizziness and vertigo, occur in about one-third of migraineurs. The most frequent and consistent balance symptom in migraineurs is motion sickness, which is experienced by about half of migraineurs and may be related to serotonergic influences. This double-blind, placebo-controlled, crossover pilot study was designed to test the hypothesis that pre-treatment with the serotonin agonist rizatriptan would prevent motion sickness provocation in headache-free migraineurs.

Ten healthy adult migraineurs (5 migrainous vertigo and 5 migraine without associated vestibular symptoms) with a history of motion sickness were tested in three sessions: a baseline vestibular battery and two motion sickness provocation sessions two hours following randomly ordered blinded pre-treatment with either oral rizatriptan 10 mg or placebo. Motion sickness was assessed using two standardized questionnaires.

Motion sickness scores were lower following pre-treatment with rizatriptan compared with placebo in subjects with migrainous vertigo. Rizatriptan did not affect motion sickness in migraineurs without vertigo. Otolith-ocular reflex sensitivity was reduced following pretreatment with rizatriptan in both groups.

This is the first study in humans testing a triptan serotonin agonist as a preventive tool for motion sickness. Rizatriptan prevented the development of motion sickness and severe motion sickness symptoms in patients with migrainous vertigo. These pilot data suggest a possible role for serotonin in the development of motion sickness symptoms in migraineurs with migrainous vertigo.