Acetazolamide for Migraine

Acetazolamide, sold under brand names Diamox and Diamox Sequels or as a generic drug, has attracted some attention as a migraine treatment. Is acetazolamide for migraine something that should be investigated further?

Finding treatments for migraine is very much like detective work. Finding connections, testing hypotheses, making gradual discoveries. This has been the case in the slow study of acetazolamide for migraine.

The first connection was found unexpectedly in 1978. Patients who had been misdiagnosed were given the drug, and the results were remarkably positive.

Acetazolamide became a choice drug for treating a type of ataxia which is common in familial hemiplegic migraine. This particular type of ataxia includes muscle symptoms – unsteadiness and a loss of coordination – along with vertigo and nausea. This type of migraine and these symptoms have a clear genetic connection.

Now this particular medication is far from a cure for this type of migraine; it’s usually given simply to treat the ataxia (episodic ataxia type 2). But there were some reports of improvement with other symptoms.

No one is sure why acetazolamide for migraine helps in some cases, or even why it treats ataxia. It does share at least one quality with topiramate (Topamax)carbonic anhydrase inhibition. Topiramate is often used as a migraine preventative. And Diamox Sequels is used, like Topamax, as an anticonvulsant.

Some reports were coming in of patients with other types of migraine being helped by acetazolamide, so a trial was designed with a dose of 500mg. Unfortunately, the study could not be completed because more than a third of the patients dropped out due to side effects. Common side effects include nausea, a tingling sensation, diarrhea, drowsiness, and occasional confusion.

Although the research continues, and the drug seems to help some patients, so far it’s not looking like Diamox will be a widespread migraine treatment.

However, the connections to headache remain intriguing. For example, acetazolamide is often used to treat glaucoma, to decrease pressure in the eye. It also helps with other symptoms such as nausea, vertigo, and headache.

It also appears that acetazolamide may interrupt cortical spreading depression, a part of the migraine chain-reaction, and so interrupt migraine aura.

Although acetazolamide probably won’t be prescribed to you because of migraine, it may be prescribed for another reason. If so, watch to see if your migraine symptoms improve, and let your doctor know. Your experience may help us understand why acetazolamide helps fight migraine in some cases but not others.

Read more about acetazolamide for migraine here.

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2 comments… add one
  • Angie Feb 21, 2015

    Acetazolamide is also used to treat Intracranial Hypertension, which is the general term for the neurological disorders in which cerebrospinal fluid (CSF) pressure within the skull is too high. (Old names for IH include Benign Intracranial Hypertension and Pseudotumor Cerebri). (Taken from the Intracranial Hypertension Research Foundation’s website.) The two most common symptoms, to my knowledge, are unrelenting, constant headaches (sometimes referred to as “suicide headaches”, because the only way to get relief is to reduce the pressure), and swollen optical nerves. Acetazolamide somehow reduces the amount of CSF in the skull, helping to relieve the headaches and other symptoms, that are many and varied. I’m very interested to see any more studies on acetazolamide helping migraines, though I do agree that studies would be difficult because of the side effects from the medication.

  • Cooeri Feb 27, 2015

    I can attest to the effectiveness of acetazolamide for migraines. I have had migraines since I was 9 years old. In 2004 the headaches changed, I was relieved to find out they were not the result of a tumor but benign intracranial hypertension. I was put on acetazolamide to protect my optic nerves. Even after all signs of the ” different” headaches disappeared I was still taking the meds and noticed I had been headache free for months. I was taken off of the meds because it was said everything was back to normal, and my migraines returned. The doctor checked to make sure the (BIH) did not return and it had not. It was the return of my migraines. Who would have thought! So now I take it only when I have a migraine along with pain relief and pain is gone within 45 mins compared to taking the Pain relief alone which can take hours or sometimes not at all. Just my experience. The biggest concern is that it has diuretic properties so ones electrolytes can be thrown off. The medicine should only be used under direct supervision of a physician.

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