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Multigenerational Women With Migraine and Early Stroke
Authors:
Sidish S. Venkataraman, BSA; Jocelyn E. Abraham, BA; Fatima Aly, MD; and Lynnette J. Mazur, MD, MPH
Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas
Citation:
Venkataraman SS, Abraham JE, Aly F, Mazur LJ. Multigenerational women with migraine and early stroke [published online October 5, 2018]. Neurology Consultant.
A 15-year-old girl with a history of chronic migraine presented to the clinic with what she called the worst headache of her life. She described the pain as bifrontal, throbbing, and associated with photophobia, photopsia, phonophobia, blurred vision, and perioral tingling. She denied any changes in speech or weakness in her arms or legs.
History. Her migraines had started at age 12 and were usually preceded by up to 30 minutes of photopsia, or migraines with aura (MA). They occurred 4 to 6 times per week. Diet history revealed that she regularly skipped meals and had poor sleep hygiene; she took 2- to 3-hour naps after school and slept at night from 1 am to 6 am. Her maternal family history included 4 generations of women with MA and early stroke (Figure 1).
Figure 1. A pedigree outlining the patient’s family history of migraine and stroke.
Physical examination. The only pertinent physical finding was a body mass index of 35.9 kg/m2 (99th percentile). No neurologic abnormalities were noted.
Diagnostic tests. Computed tomography (CT) and CT angiography (CTA) performed in the emergency department showed no signs of hemorrhage or vascular occlusion. Later, magnetic resonance imaging showed punctate foci of T2/FLAIR (fluid-attenuated inversion recovery) hyperintense signal in the periventricular and deep white matter of the frontal lobes, which may be sequelae of migraines (Figure 2).
Figure 2. T2-weighted MRI of the brain taken on the day of presentation. Circled in red are two examples of the punctate hyperintense signal seen in the periventricular and deep white matter of the frontal lobes. These changes likely are sequelae of migraines.
Propranolol and vitamin D supplements were prescribed, and regular meals and a better sleep routine were recommended.
NEXT: Discussion
Authors:
Sidish S. Venkataraman, BSA; Jocelyn E. Abraham, BA; Fatima Aly, MD; and Lynnette J. Mazur, MD, MPH
Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas
Citation:
Venkataraman SS, Abraham JE, Aly F, Mazur LJ. Multigenerational women with migraine and early stroke [published online October 5, 2018]. Neurology Consultant.
A 15-year-old girl with a history of chronic migraine presented to the clinic with what she called the worst headache of her life. She described the pain as bifrontal, throbbing, and associated with photophobia, photopsia, phonophobia, blurred vision, and perioral tingling. She denied any changes in speech or weakness in her arms or legs.
History. Her migraines had started at age 12 and were usually preceded by up to 30 minutes of photopsia, or migraines with aura (MA). They occurred 4 to 6 times per week. Diet history revealed that she regularly skipped meals and had poor sleep hygiene; she took 2- to 3-hour naps after school and slept at night from 1 am to 6 am. Her maternal family history included 4 generations of women with MA and early stroke (Figure 1).
Figure 1. A pedigree outlining the patient’s family history of migraine and stroke.
Physical examination. The only pertinent physical finding was a body mass index of 35.9 kg/m2 (99th percentile). No neurologic abnormalities were noted.
Diagnostic tests. Computed tomography (CT) and CT angiography (CTA) performed in the emergency department showed no signs of hemorrhage or vascular occlusion. Later, magnetic resonance imaging showed punctate foci of T2/FLAIR (fluid-attenuated inversion recovery) hyperintense signal in the periventricular and deep white matter of the frontal lobes, which may be sequelae of migraines (Figure 2).
Figure 2. T2-weighted MRI of the brain taken on the day of presentation. Circled in red are two examples of the punctate hyperintense signal seen in the periventricular and deep white matter of the frontal lobes. These changes likely are sequelae of migraines.
Propranolol and vitamin D supplements were prescribed, and regular meals and a better sleep routine were recommended.
