Role of acetazolamide in treatment of patients with menstrual migraine

Objective: According to the ICHD-3 criteria, menstrual migraine (MM) is divided into two groups: pure menstrual migraine (PMM) and menstrually-related migraine (MRM). The present study aimed to evaluate and compare the severity of headache using a visual analog scale (VAS) and the effect on quality of life using the Headache Impact Test (HIT) and Migraine Disability Assessment (MIDAS) tests before and after 3 months of treatment in using short-term prophylaxis with acetazolamide. Methods: Patients who presented to the headache outpatient clinic of the neurology department with a diagnosis of MM were retrospectively reviewed. Acetazolamide was given at a dosage of 500 mg daily for 5 days starting two days before the predicted onset of the menstrual cycle as a short-term prophylactic treatment. VAS, MIDAS, and HIT assessments were performed before and after treatment. Results: A total of 26 patients with PMM and 26 patients with MRM were identified. After acetazolamide treatment, statistically significant improvement was found in MIDAS, VAS and HIT scores in both groups of patients. The post-treatment MIDAS score was significantly lower in the MRM group, but there was no significant difference in post-treatment VAS and HIT scores between the groups. Conclusion: Using acetazolamide for short-term prophylaxis in patients with MM leads to decreased severity and frequency of headache and improvement in quality of life. The study is the first in the literature to use acetazolamide for short-term prophylaxis in patients diagnosed with MM.