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acetazolamide

Acetazolamide for Migraine

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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.

What is Persistent Migraine Aura?

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Persistent Migraine Aura

Persistent Migraine Aura (PMA)

persistent aura without infarction

Migraine aura (ie visual) which hangs around for more than a week (and could last for years).

Proper diagnosis:

To be diagnosed, it must occur in a patient who has had previous migraine attacks with aura.  Death of brain cells (infarction), and other related disorders must be ruled out.

Symptoms

Aura symptoms, and especially visual aura symptoms such as:

  • Visual snow
  • Flashing lights
  • Patterns

Treatments

Drugs such as acetazolamide, valproic acid, furosemide, verapamil, and lamotrigine

Nothing has been found that works for everyone.
PMA can be very difficult to treat.

For more information, read Persistent Migraine Aura and Visual Snow? and Visual Snow and Persistent Migraine Aura – tests and treatments

Selected References:  The visual aura rating scale as an outcome predictor for persistent visual aura without infarction. Cephalalgia 2008; The International Classification of Headache Disorders 2nd edition 2003; Is ‘visual snow’ a symptom of migraine? Dr Paul Shanahan; Is Visual Snow a Migraine Aura?; Migraine with Persistent Visual Aura: Response to Furosemide Clinics 2009; It’s snowing! Seven cases of persistent migrainous visual aura Saint Louis University; The visual aura rating scale as an outcome predictor for persistent visual aura without infarction. Cephalalgia 2008

Visual Snow and Persistent Migraine Aura – tests and treatments

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In the last post we introduced two concepts – visual snow (VS) and persistent migraine aura (PMA).  The first is a specific symptom which can have a number of causes; the second a diagnosis which can include the first.

First, persistent migraine aura (PMA) is diagnosed when other causes are ruled out.  But as we’ve said there are a number of things that can cause visual snow (VS).

Doctors will take a careful drug history for patients with VS, because one cause is hallucinogenic drugs.  The drug may only have been taken once, and time may have passed since it was taken, but it can have permanent effects.

Optic neuritis, an inflammation of the optic nerve, can also be a cause.  Optic neuritis usually develops from an autoimmune disorder.  Read more about optic neuritis here.

There are many other things that can be involved – even vitamin deficiencies.

Dr. Klaus Podoll, Dr. Markus Dahlem and Sofia Greene list common tests that are done for persistent aura symptoms here.  These include:

  • Ophthalmologic examination
  • Neurological examination
  • Psychiatric examination
  • Thorough headache history and family history
  • Thorough drug history (including illegal drugs, especially hallucinogens: LSD, Ecstasy, mushrooms, other?)
  • CAT or MRI of head (the MRI is important to rule out what is called a migrainous infarction)

Other examinations may follow, including an EEG, evoked potentials (a testing of the functioning of the nervous system), blood work, and a lumbar puncture.

Obviously, if anything shows up on these tests, you’ll be following that up.

Assuming these treatments are out of the way, there are some treatments that have been tried, with some success.  There is no tried-and-true established treatment, but some options include:

  • valproic acid
  • acetazolamide
  • lamotrigine (particularly for VS not classified as PMA)
  • topiramate (Topamax)

Sometimes injections of furosemide (frusemide) are used, if other treatments fail.  Clonazepam is also used for patients who have symptoms from hallucinogenic drugs.

Do you have experience with ongoing migraine aura, or visual snow?  Have you found anything that has helped?  How did the symptoms start?

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The articles on Headache and Migraine News are © 2004-2026 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.