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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.

Whatever Happened to Lasmiditan?

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We last talked about Lasmiditan in 2012, with hopes that it would be on the market by now. But although a lot of money is being invested, and trials are still ongoing, it’s not likely we’ll see Lasmiditan for migraine until 2018 or later.
CoLucid
Lasmiditan is a migraine abortive and a serotonin receptor agonist, like triptans. But unlike triptans, it doesn’t seem to cause vasoconstriction – very important for those at risk of stroke and heart disease.

Lasmiditan is going to undergo phase III trials, further investigating the drugs ability to fight headache, nausea, photophobia and phonophobia. The company, CoLucid Pharmaceuticals, also has permission from the FDA to include some patients who have some cardiovascular risk factors.

Another future trial will be a pediatric study.

Lasmiditan remains a very promising migraine drug, which may be a major alternative to the familiar triptan medications. But we’ll probably be waiting until 2018 before most of us will have a chance to use it.

Read more about the development plan for Lasmiditan here.

For more, see Emerging therapeutic options for acute migraine: focus on the potential of lasmiditan

Whatever Happened to Levadex?

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We’ve been talking about the new migraine drug, Levadex, since 2010. But it’s still not on the market. Will it ever be?

AllerganLevadex was still in the news last year, but under a brand new name. Semprana is the new name for Levadex, a new formulation of dihydroergotamine mesylate (DHE). It’s now owned by Allergan, the makers of Botox.

Semprana is an inhaled migraine abortive. It looks especially promising for nausea, and sensitivity to light and sound.

But last summer, Semprana was rejected yet again by the FDA in the United States. That’s the third time. The good news is that the rejection had nothing to do with whether or not Semprana works, or whether or not it’s safe. Instead, the FDA had technical concerns about the manufacturing and functioning of the device.

Semprana remains in Allergan’s pipeline, and is still looking like it could be a big player in the migraine market. But consumers probably won’t be seeing it in the local pharmacy until 2017.

The Best Medication for Migraine? The AHS Reports

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Last month the American Headache Society came out with a new report suggesting which drugs have the best evidence behind them when it comes to migraine. According to the trials, what works the best?

Best Meds 2015This, of course, does not mean that these medications will work the best for you. There is a lot of variation within migraine, and your doctor will help you decide where to start.

However, if your doctor isn’t talking about some of the treatments at the top of the list, you should be asking some questions.

The full report can be found here: The Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies. However, here is a summary of some of the authors’ findings.

The medications with the best evidence behind them included:

  • The Triptans: Certain specific triptan medications were mentioned, such as almotriptan, sumatriptan, and naratriptan
  • Butorphanol nasal spray
  • NSAIDs: aspirin, diclofenac, ibuprofen and naproxen
  • Acetaminophen, but only for “non-incapacitating attacks”
  • DHE
  • Acetaminophen/aspirin/caffeine combo
  • Sumatriptan/naproxen combo

Some of the medications that really don’t have good evidence behind them, or the evidence is conflicting at this time, include:

  • Lidocaine IV
  • Celecoxib
  • Hydrocortisone IV

This is only a portion of the list – most medications fall between these two extremes. Also, it’s important to note that the researchers noted actual dosages, which means of course that any particular medication may work better/worse at a different dosage, but it may not have been studied.

Also, remember that these are only “acute” medications – taken at the time of an attack – not preventatives.

The conclusion of the study offers an appropriate warning:

According to this systematic review of the literature and structured grading of the evidence strength, specific medications within the following classes are considered “effective” for the acute therapy of migraine: triptans, ergotamine derivatives, NSAIDs, opioids, and combination medications. Several other medications are considered “probably effective” or “possibly effective.” This evidence base for medication efficacy should be considered along with potential medication side effects, potential adverse events, patient-specific contraindications to use of a particular medication, and drug-to-drug interactions when deciding which medication to prescribe for acute therapy of a migraine attack.

Amerge for Cluster Headaches

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Is Amerge for cluster headaches an overlooked treatment?

Amerge or Naramig are brand names for naratriptan, another in the triptan class of medications which include sumatriptan and zolmitriptan. Triptans are commonly used for both cluster and migraine.

Triptan optionsTriptans were gradually introduced into the market starting in 1991 with sumatriptan. But this gradual release has perhaps caused some problems which are true for migraine patients but magnified when it comes to cluster.

Naturally, the first triptan to arrive has been studied the most. Maybe it’s more because of this and less because of its effectiveness that sumatriptan has become the go-to triptan for cluster.

Because cluster is so rare, and because of challenges in running clinical trials, it will be a long time, if ever, before we have good data on whether Amerge for cluster headaches, or another triptan, is the best option – and for what type of patient.

The other challenge is that the newer triptans are less likely to have better (faster) delivery methods – such as nasal sprays and injections.

Naratriptan has been used as an add-on to high dose verapamil treatment (Naratriptan in the preventive treatment of cluster headache.). This cluster case study in 2002 showed a 2.5 mg twice daily dose of naratriptan completely stopping cluster headache in a 36 year old male. And naratriptan is being used, though maybe not as much as it should be.

The best advice for doctors and patients is probably the advice that’s often given in the case of migraine. If one triptan doesn’t work at all, or not as well as you hoped, you may have much better success with another. Talk to your doctor about trying another option. Amerge may be one to try next.

For more on triptans, check out:

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The articles on Headache and Migraine News are © 2004-2025 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.