Efficacy And Tolerability of Acetazolamide in Migraine Prophylaxis and Klinefelter Syndrome: A Case Report

P390Efficacy and Tolerability of Acetazolamide inMigraine Prophylaxis and Klinefelter Syndrome:A Case ReportR. Nardello1, P. Glorioso1, M. Saladino1, M. Moscarelli1,A. Fontana1, S. Mangano11Dipartimento di Scienze per la Promozione della Salute eMaterno Infantile ‘‘G. D’Alessandro’’, University of Palermo,Palermo, PA, Italy.Objectives: We describe an interesting case of migraineheadaches with aura in a 47, XXY male KlinefelterSyndrome (KS) intreatment with Acetazolamide and resolutionofsymptoms.Background: A 16-year-old boy presented to the outpatientclinic migraine headaches throbbing, onset eveningthat lasts for a week and is presented once a month withaura, associated with nausea and vomiting.Methods: The boy is a preterm at 28 WG for gestosis,the birth weight was 800 gr. He presented psychomotorretardation, and flat feet, and scoliosis. On neurologicalexamination cranial nerves were intact. Detailed testingof motor strength, sensory exam, gait and coordinationwas also normal, as were his reflexes. Plantar responseswere flexor bilaterally. The EEG was normal. He presentedtall stature, abdominal adiposity and small testicles. Thekaryotype 47, XXY showed the presence of KS. Thefinal diagnosis was new onset migraine headache withaura in patient with KS. Due to the frequency of his headachesand the disability associated he was treated with aprophylactic medication, before with Levetiracetam andthen Topiramate and then Flunarizine without resolutionof symptoms.Results: Afterintroduction prophilaxis with acetazolamideinan oral dose of 500 mg dailysymptoms haveresolved.Patients with KS have reduced testosterone andincreased circulating estradiol. Migraine is suspected tobe intimately connected with increased circulating levelsof estradiol. In our patient the 17-B- extradiolo at thesame timeof migraine attackswas high. After introductionprophylaxis with acetazolamide for a period of sixmounth thepatient experienceda reduction inmigraineattacks.Conclusions: Our case report supports the importanceof hormonal influences in migraine headaches, while alertingphysicians to consider unusual causes of hormonaldysregulation, such as KS in male patients presentingwith new-onset headaches.