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

P390 Efficacy and Tolerability of Acetazolamide in Migraine Prophylaxis and Klinefelter Syndrome: A Case Report R. Nardello1, P. Glorioso1, M. Saladino1, M. Moscarelli1, A. Fontana1, S. Mangano1 1Dipartimento di Scienze per la Promozione della Salute e Materno Infantile ‘‘G. D’Alessandro’’, University of Palermo, Palermo, PA, Italy. Objectives: We describe an interesting case of migraine headaches with aura in a 47, XXY male Klinefelter Syndrome (KS) intreatment with Acetazolamide and resolutionof symptoms. Background: A 16-year-old boy presented to the outpatient clinic migraine headaches throbbing, onset evening that lasts for a week and is presented once a month with aura, associated with nausea and vomiting. Methods: The boy is a preterm at 28 WG for gestosis, the birth weight was 800 gr. He presented psychomotor retardation, and flat feet, and scoliosis. On neurological examination cranial nerves were intact. Detailed testing of motor strength, sensory exam, gait and coordination was also normal, as were his reflexes. Plantar responses were flexor bilaterally. The EEG was normal. He presented tall stature, abdominal adiposity and small testicles. The karyotype 47, XXY showed the presence of KS. The final diagnosis was new onset migraine headache with aura in patient with KS. Due to the frequency of his headaches and the disability associated he was treated with a prophylactic medication, before with Levetiracetam and then Topiramate and then Flunarizine without resolution of symptoms. Results: Afterintroduction prophilaxis with acetazolamidein an oral dose of 500 mg dailysymptoms haveresolved. Patients with KS have reduced testosterone and increased circulating estradiol. Migraine is suspected to be intimately connected with increased circulating levels of estradiol. In our patient the 17-B- extradiolo at the same timeof migraine attackswas high. After introduction prophylaxis with acetazolamide for a period of six mounth thepatient experienceda reduction inmigraine attacks. Conclusions: Our case report supports the importance of hormonal influences in migraine headaches, while alerting physicians to consider unusual causes of hormonal dysregulation, such as KS in male patients presenting with new-onset headaches.