To evaluate the efficacy and safety of triptans in the acute treatment of Vestibular Migraine (VM) attacks.

VM is a well-defined diagnostic entity characterized by recurrent vertigo attacks, unexplained by other central or peripheral otologic abnormalities, in patients with a history of migraine. Triptans, widely used for migraine headache, have been investigated as potential therapies for VM.

We conducted a systematic review and network meta-analysis of randomized clinical trials assessing triptans for acute VM treatment. Databases were searched through 2025. Eligible studies included adults with VM attacks treated with triptans versus placebo or other comparators. Outcomes included reduction in vertigo/dizziness at 1 hour, complete symptom resolution at 1 hour, improvement in headache and associated symptoms, rescue medication use, and adverse events. Pooled effect sizes were estimated using Bayesian network meta-analysis models.

Four randomized clinical trials (n = 201 participants) evaluated rizatriptan 10 mg and zolmitriptan 2.5 mg versus placebo or symptomatic therapy. Rizatriptan improved vestibular symptoms at 1 hour, reducing moderate/severe vertigo in 48.3% vs 26.4% with placebo. Dizziness improved in 19.2% of rizatriptan-treated participants. Headache and associated symptoms improved in 86–93% of treated patients at 24 hours, although direct placebo comparisons were inconsistent. Zolmitriptan showed a benefit at 2 hours (38% vs 22% placebo) but was underpowered. Adverse events were mild and did not lead to discontinuation. No serious adverse events occurred.

Triptans, particularly rizatriptan, demonstrate promising efficacy for acute VM, improving vestibular and headache symptoms with a favorable safety profile. Larger randomized trials are needed to confirm these findings and guide clinical recommendations.