Can Diamox (Acetazolamide) cause headaches?

Diamox (Acetazolamide) and Headaches

Yes, Diamox (acetazolamide) can cause headaches as a side effect, and it has been documented in clinical guidelines as one of its potential adverse effects. 1

Mechanism and Side Effect Profile

Acetazolamide is a carbonic anhydrase inhibitor commonly used for:

• Prevention of altitude sickness
• Treatment of glaucoma
• Management of idiopathic intracranial hypertension
• Other conditions requiring reduction of cerebrospinal fluid production

Common Side Effects of Acetazolamide

• Paresthesias (tingling sensations)
• Vertigo
• Alteration of taste
• Allergic dermatitis/conjunctivitis
• Headaches

Serious Side Effects

• Kidney stones
• Metabolic acidosis
• Blood dyscrasias
• Stevens-Johnson syndrome
• Serum electrolyte imbalances
• Lethargy
• Suppression of appetite 1

Paradoxical Effects on Headaches

Interestingly, acetazolamide has a complex relationship with headaches:

1. Can Cause Headaches: As a direct side effect of the medication 1

2. Can Treat Certain Headaches: Paradoxically, acetazolamide has been used to treat specific headache disorders:

   • It has been reported to successfully treat chronic paroxysmal hemicrania in a patient who failed to respond to indomethacin 2
   • It has shown efficacy in treating headaches associated with increased intracranial pressure 3
   • Recently, it was found effective in treating treprostinil-induced headaches in a patient with pulmonary arterial hypertension 4

Clinical Management Considerations

If a patient develops headaches while taking acetazolamide:

1. Evaluate the timing and pattern of headaches in relation to medication administration

2. Consider dosage adjustment:

   • Standard dosing for altitude sickness prevention is 125-250 mg twice daily 1
   • Higher doses increase risk of side effects including headaches

3. Monitor for other side effects that may accompany headaches:

   • Paresthesias
   • Dizziness
   • Altered taste
   • Increased urination
   • Metabolic acidosis 1

4. Watch for drug interactions:

   • Limit caffeine intake as it may worsen side effects including headaches 1
   • Avoid combining with other diuretics due to increased risk of dehydration and electrolyte imbalances 1

5. Ensure adequate hydration as dehydration from the diuretic effect can worsen headaches

When to Consider Discontinuation

Consider discontinuing acetazolamide if:

• Headaches are severe or persistent
• Other significant side effects develop
• The benefit of the medication no longer outweighs the side effect burden

Alternative Medications

If acetazolamide must be discontinued due to headaches:

• For altitude sickness: Consider dexamethasone as an alternative
• For glaucoma: Beta-blockers, alpha agonists, or prostaglandin analogs may be options
• For idiopathic intracranial hypertension: Topiramate or furosemide might be alternatives

Remember to monitor patients closely when switching medications and to address any underlying conditions that may be contributing to headaches.