Abstract

Background: Serotonergic triptan medications effectively reverse pain andassociated symptoms of migraine. Vestibular symptoms, including dizziness and vertigo, occur in aboutone-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. Thisdouble-blind, placebo-controlled, crossover pilot study was designed to test the hypothesis that pre-treatmentwith the serotonin agonist rizatriptan would prevent motion sickness provocation in headache-free migraineurs.Material/Methods: Ten healthy adult migraineurs (5 migrainous vertigo and 5 migraine without associatedvestibular symptoms) with a history of motion sickness were tested in three sessions: a baseline vestibularbattery and two motion sickness provocation sessions two hours following randomly ordered blinded pre-treatmentwith either oral rizatriptan 10 mg or placebo. Motion sickness was assessed using two standardized questionnaires.Results: Motion sickness scores were lower following pre-treatment with rizatriptan compared with placeboin subjects with migrainous vertigo. Rizatriptan did not affect motion sickness in migraineurs withoutvertigo. Otolith-ocular reflex sensitivity was reduced following pretreatment with rizatriptan in bothgroups. Conclusions: This is the first study in humans testing a triptan serotonin agonist as a preventivetool for motion sickness. Rizatriptan prevented the development of motion sickness and severe motionsickness symptoms in patients with migrainous vertigo. These pilot data suggest a possible role for serotoninin the development of motion sickness symptoms in migraineurs with migrainous vertigo.

Keywords: Cross-Over Studies, Double-Blind Method, Migraine Disorders - drug therapy, Motion Sickness - physiopathology, Placebos, Serotonin Receptor Agonists - therapeutic use, Triazoles - therapeutic use, Tryptamines - therapeutic use