Efficacy and tolerability of acetazolamide in migraine prophylaxis: a randomised placebo-controlled trial.
BACKGROUND
Familial hemiplegic migraine and episodic ataxia type 2 (EA2) are allelic disorders with distinct types of mutations in the CACNA1A gene. EA2 attacks are remarkably sensitive to acetazolamide, a carbonic anhydrase inhibitor. The effectiveness of acetazolamide in migraine prophylaxis is unknown.


OBJECTIVE
To evaluate the efficacy and the tolerability of acetazolamide in migraine prophylaxis.


METHODS
We compared daily oral 500 mg acetazolamide and placebo in patients with migraine in a multicentre, double-blind, randomised trial of 12 weeks duration after a run-in period of 4 weeks without treatment. Frequency of attacks at the last trial period of 4 weeks was the primary efficacy criterion. Secondary efficacy criteria were the frequency of attacks per 4 weeks, the severity and duration of attacks, the number of hours with migraine as well as the number of responders with more than 50% reduction in attack frequency.


RESULTS
53 patients had been enrolled when the study was prematurely stopped because of a high number of withdrawals (34%), primarily linked to acetazolamide related side effects. Considering the primary and secondary efficacy criteria, among the 53 included patients (27 in the placebo group and 26 in the acetazolamide group), no difference between the 2 study groups could be demonstrated. The most frequent adverse events related to acetazolamide were paresthesias and asthenia.


CONCLUSIONS
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.
Vahedi
K
K
Service de Neurologie Hĵpital Lariboisière, Paris, France. vahedi@ccr.jussieu.fr
Taupin
P
P
Djomby
R
R
El-Amrani
M
M
Lutz
G
G
Filipetti
V
V
Landais
P
P
Massiou
H
H
Bousser
M G
MG
D000086:Acetazolamide / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D020865:Calcium Channels, P-Type / Q000187:drug effects* / Q000378:metabolism; D002257:Carbonic Anhydrase Inhibitors / Q000009:adverse effects*; D004361:Drug Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000139:chemically induced; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control*; D010292:Paresthesia / Q000139:chemically induced; D010349:Patient Compliance; D012894:Sleep Stages / Q000187:drug effects; D016896:Treatment Outcome
D001639:Bicarbonates; D020865:Calcium Channels, P-Type; D002257:Carbonic Anhydrase Inhibitors; D000086:Acetazolamide