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.