One daily as-needed medication for acute migraine relief is rizatriptan, which has a number of associated side effects that may occur to varying degrees and frequency among users. Side effects occur in 14 – 20% of patients, and common side effects include dizziness, fatigue and somnolence12. A recent study in the Journal of Headache and Pain found that dizziness was one of the top reasons adults discontinued rizatriptan, with close to 17% reporting this symptom. Fatigue is a close second, with almost 10% likely being affected and this has more to do how the drug interacts on your central nervous system.
Side-effects rizatriptan also expresses itself in head and neck. In 2022 meta-analysis, chest tightness/pressure (in addition to neck and jaw) occurs in approximately 5-8% of cases. Although mild and self-limited, they can be alarming to patients who are unfamiliar with these sensations secondary to acute treatment with a triptan. However, the American Migraine Foundation suggests patients keep an eye for these effects and let their health care provider know if they intensify.
One of the more common categories are rizatriptan side effects that fall under gastrointestinal problems. Nausea remains uncommon (approximately 7% of patients, especially within the first hour after dosing). And worse, because nausea is already one of the symptoms experienced by patients to whom Zomig might be most likely prescribed (such as for itself an agonizing migraine aura), this side effect only serves to add yet more misery on top. However a study published in Cephalalgia during 2021 found that titrating down from 10 mg to just 5 mg had reduced nausea by nearly half, thus demonstrating clear dose-responsive effect [8].
Less common, but also important to note are cardiovascular effects. Rizatriptan may have a transient effect on blood pressure and caution should be taken in those with that history of hypertension. For most healthy users, the elevations in blood pressure if any are not of medical relevance although this issue remains subject to debate. Nonetheless, the drug remains contraindicated in known cardiovascular disease (as the vasoconstrictive effects of triptans could theoretically cause these serious events) and non-high-risk patients with a history of migraine should be evaluated accordingly.
Serotonin syndrome (it is unlikely but more severe side effects) may occur if rizatriptan and other serotonergic drugs are taken together. Its overall incidence rate is low (approx. 0.1%) but this presents a potentially lethal hazard with symptoms including agitation, confusion rapid heart rate and high blood pressure[, ] Specifically, the FDA has warned that patients on serotonergic drugs should be closely monitored in case they develop such symptoms (especially those taking multiple agents affecting serotonin).
Rizatriptan's high rates of pain relief within two hours have led to its widespread use, despite utilization being curtailed by cardiovascular safety concerns. It odds that the benefit-to-risk ratio is in its favor, as most of the side effects are mild and self-limiting. When adverse events occur, dose adjustments or substitution of a different form of triptan may be better tolerated by the patient.
Based on these results, the most frequently occurring rizatriptan side effects are mild such as dizziness and fatigue. Knowledge of these specific risks allows patients and healthcare providers to decide on the most suitable ways of managing migraine treatment effectively with minimal side effects.