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Introduction: A person’s sex and/or gender may influence the pathogenesis, presentation, and therapeutic response to disease; yet, the impact of sex and gender is not routinely evaluated in medical research, nor adequately emphasized in medical school curricula. Little is known about medical school faculty knowledge and attitudes regarding sex and gender-based medicine (SGBM). Methods: We administered an online survey to 158 faculty members at WMU Homer Stryker M.D. School of Medicine. The survey of knowledge on SGBM was adapted from two prior surveys used in medical student and resident populations and modified for faculty participants. Hidden curriculum theory, which proposes students learn through formal curriculum as well as through passive perceptions of faculty and institutional attitudes, was used as a theoretical lens. Results: Thirty-eight of 158 recipients completed the survey, for a 24% response rate. Respondents answered an average of 48.53% of the knowledge questions correctly; percent correct did not differ significantly between men and women faculty members (P= .2732). Seventy one percent of respondents indicated it was important or very important to consider sex and gender when providing patient care. Only 24% indicated they had some formal or continuing education on the topic. Respondents indicated interest in educational opportunities for SGBM in the form of online modules or lectures. Conclusion: Though faculty respondents endorsed SGBM, few have had formal education related to the topic. Faculty development on SGBM may close knowledge gaps and facilitate integration of this curriculum. The survey tool developed through this project may be useful for other institutions engaged in similar efforts related to SGBM.

ImportanceVestibular migraine has no established treatments.ObjectiveTo test the efficacy of rizatriptan for treating vestibular migraine attacks.Design, Setting, and ParticipantsThis double-blind, randomized clinical trial of rizatriptan vs placebo was conducted from December 2014 through July 2020 (data analyses in 2021 and sensitivity analyses in 2022 and 2024) at 2 tertiary neurotologic centers. Adults with vestibular migraine were included.InterventionAll participants underwent prospective observation to confirm diagnosis and illness activity and were then randomized in a 2:1 ratio to receive rizatriptan 10 mg or placebo to treat up to 3 vestibular migraine attacks per participant.Main Outcomes and MeasuresParticipants rated symptoms as absent, mild, moderate, or severe at scheduled intervals. Primary outcomes were the percentage of attacks with reductions in vertigo and unsteadiness/dizziness from moderate or severe to absent or mild at 1 hour. Secondary outcomes were the percentage of attacks with complete resolution of vestibular symptoms at 1 hour; reductions in headache and associated symptoms at 1 hour; use of rescue medications after 1 hour; reductions in vestibular, headache, and associated symptoms at 24 hours without rescue medications; treatment satisfaction and quality of life at 48 hours; and rates of serious adverse effects and discontinuation due to adverse effects.ResultsOf 222 total participants (mean [SD] age, 42.3 [11.7] years; 70.7% were women), 134 (60.4%) with active illness treated 307 attacks. Efficacy was tested using 240 attacks with vestibular symptoms rated as moderate or severe when participants took study drug. At 1 hour, rizatriptan did not differ from placebo for reducing vertigo (73/151 [48.3%] vs 50/88 [56.8%] attacks; odds ratio [OR], 0.71 [95% CI, 0.42-1.21]), unsteadiness/dizziness (29/151 [19.2%] vs 11/89 [12.4%] attacks; OR, 1.69 [95% CI, 0.80-3.57]), or any secondary outcomes. Similar percentages of participants in rizatriptan and placebo groups (26.4% for both groups) added rescue remedies after 1 hour. At 24 hours, rizatriptan had medium effects over placebo for unsteadiness/dizziness (OR, 2.65) and motion sensitivity (OR, 3.58). Post hoc analyses of all treated attacks found a medium effect favoring rizatriptan for headache and photophobia or phonophobia at 24 hours. Treatment satisfaction was equivocal. Quality of life was mixed. No participants experienced serious adverse effects or discontinued treatment for adverse effects.Conclusions and RelevanceIn this study, rizatriptan was ineffective at 1 hour for treating vestibular migraine attacks and had limited benefit on symptoms at 24 hours. Findings do not support using rizatriptan for vestibular migraine attacks.Trial RegistrationClinicalTrials.gov Identifier: NCT02447991

This Viewpoint describes the benefits and challenges of integrating genomic information with disease-modifying therapies for epilepsy.