Efficacy and tolerability of acetazolamide in migraine prophylaxis: A randomised placebo-controlled trial

Vahedi, Katayoun; Taupin, Pierre; Djomby, R.; El-Amrani, M.; Lutz, G.; Filipetti, V.; Landais, Paul; Massiou, H.; Bousser, M.-G.

doi:10.1007/pl00007866

Cited by 60 publications

(30 citation statements)

References 20 publications

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“…Even if our data derive only from a retrospective database analysis and therefore no definitive conclusion can be derived, it has to be noted that the efficacy of the drug was quite striking with a net benefit reported by five out of seven patients early after drug starting. Surprisingly, the rate of side effects reported by our CADASIL patients appears somehow lower that that expected at least in common migraine [10]. …”

Section: Discussioncontrasting

confidence: 67%

Acetazolamide for the prophylaxis of migraine in CADASIL: a preliminary experience

et al. 2012

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Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited microangiopathy caused by NOTCH3 mutations. It is characterized by migraine, with or without aura, ischemic events, psychiatric and cognitive disturbances. There is no approved treatment for migraine prophylaxis in CADASIL, but acetazolamide has been anecdotally reported to be effective. We retrospectively reviewed our database of patients with a genetic diagnosis of CADASIL to identify how many of them were treated with acetazolamide for the prophylaxis of migraine. The efficacy and the tolerability of this treatment were checked looking at the clinic reports. Acetazolamide was prescribed in seven patients; the mean duration of treatment was 6 months, and the daily dose ranged from 125 to 500 mg. Three patients had a total and sustained remission, while in two patients a reduction in attacks and an improvement of the headache intensity were recorded. In one of these, acetazolamide was deliberately taken only during the migraine attack and the beneficial effect started 1 h after administration. In two patients, the drug did not produce any beneficial effect. Mild side effects were recorded in two patients. Our preliminary experience expands previous reports and confirms the possible efficacy of acetazolamide in CADASIL migraine. Based on these data, a randomized controlled trial seems worthy to be carried out to test the efficacy and safety of this drug.

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Section: Discussioncontrasting

confidence: 67%

Acetazolamide for the prophylaxis of migraine in CADASIL: a preliminary experience

et al. 2012

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“…This study had to be interrupted prematurely due to many side effects related withdrawals. So far, the authors did not find a difference between the active drug and placebo 118 . Acetazolamide was also shown to interrupt aura status in 3 patients 119 …”

Section: The Acetazolamide Effectmentioning

confidence: 91%

The Cerebellum and Migraine

Vincent¹,

Hadjikhani²

2007

Headache

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Clinical and pathophysiological evidences connect migraine and the cerebellum. Literature on documented cerebellar abnormalities in migraine, however, is relatively sparse. Cerebellar involvement may be observed in 4 types of migraines: in the widespread migraine with aura (MWA) and migraine without aura (MWoA) forms; in particular subtypes of migraine such as basilar-type migraine (BTM); and in the genetically driven autosomal dominant familial hemiplegic migraine (FHM) forms. Cerebellar dysfunction in migraineurs varies largely in severity, and may be subclinical. Purkinje cells express calcium channels that are related to the pathophysiology of both inherited forms of migraine and primary ataxias, mostly spinal cerebellar ataxia type 6 (SCA-6) and episodic ataxia type 2 (EA-2). Genetically driven ion channels dysfunction leads to hyperexcitability in the brain and cerebellum, possibly facilitating spreading depression waves in both locations. This review focuses on the cerebellar involvement in migraine, the relevant ataxias and their association with this primary headache, and discusses some of the pathophysiological processes putatively underlying these diseases.

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“…In addition, although DPN is recognized in patients with miscellaneous cerebellar disorders [2], it may be useful for diagnosing FHM1. Acetazolamide is already known to depress the paroxysmal symptoms of FHM1 [16], [17]. Among many patients with migraine, there may be patients similar to our patient 3.…”

Section: Discussionmentioning

confidence: 55%

Downbeat positioning nystagmus is a common clinical feature despite variable phenotypes in an FHM1 family

et al. 2008

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Clinical examination and mutational analysis were carried out in three patients of a Japanese familial hemiplegic migraine (FHM) pedigree. Each affected member demonstrated a broad clinical spectrum that included hemiplegic migraine with progressive cerebellar ataxia, migraine without aura, and episodic ataxia. Despite this variability, all members exhibited marked downbeat positioning nystagmus, and magnetic resonance images (MRI) all showed cerebellar atrophy predominantly of the cerebellar vermis. All affected members had a T666M missense mutation in the protein encoded by the CACNA1A gene (calcium channel, voltage-dependent, P/Q type, alpha 1A subunit). Although clinical features associated with the T666M CACNA1A mutation are highly variable, downbeat positioning nystagmus may be an important clinical feature of this disease.

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Efficacy and tolerability of acetazolamide in migraine prophylaxis: A randomised placebo-controlled trial

Abstract: In this trial, migraine sufferers poorly tolerated acetazolamide given in an oral dose of 500 mg daily. No obvious prophylactic beneficial effect of acetazolamide appeared on migraine attacks.

Cited by 60 publications

References 20 publications

Acetazolamide for the prophylaxis of migraine in CADASIL: a preliminary experience

Acetazolamide for the prophylaxis of migraine in CADASIL: a preliminary experience

The Cerebellum and Migraine

Downbeat positioning nystagmus is a common clinical feature despite variable phenotypes in an FHM1 family

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