According to an editorial, the mechanism of action of betahistine is well understood, and in theory it could relieve symptoms by reducing endolymphatic hydrops through improvements in microcirculation. However, the current study provides evidence that challenge the efficacy of this effect. The commentators note that Meniere’s disease is rare; and although a GP might see up to 20 new patients with vertigo per year, they will see only a few with Meniere’s disease during a whole career. The low incidence, combined with a set of symptoms that is common to other conditions often results in misdiagnoses or ill-suited prescriptions of betahistine. They add that a lack of efficacy of betahistine may not be news to the Meniere’s disease community, and the drug has no licence in the US because there is so little evidence to support its use. Furthermore, several Cochrane reviews have already concluded that betahistine is unlikely to be effective. They observe that many patients continue to take it and many doctors continue to prescribe it, possibly because of the drug’s high tolerance, low risks, lack of alternatives, and a few early anecdotal accounts of benefit. They suggest the current data could be the trigger that diverts both doctors and patients away from this popular but ineffective treatment, and might also allow a reallocation of resources to search for better alternatives.