Abstract
Cervical, anterior, and middle cerebral artery aneurysm is a causative factor for migraine, and endovascular treatment usually improves migraine headache. Posterior cerebral artery (PCA) aneurysm is a rare condition, and its association with migraine is very rarely reported. In addition, endovascular coiling treatment causing migraine-like headache has never been reported. Here, we describe a newly developed migraine-like headache with visual aura after endovascular coiling treatment for PCA aneurysm in a 31-year-old female patient. One month after the endovascular therapy, the patient stopped using the antiplatelet agents clopidogrel and aspirin and presented with an episodic headache attack twice a month with typical migraine features, including visual aura, right-sided temporal throbbing pain accompanied with nausea, vomiting, and photophobia. The recurrence of migraine-like headache with visual aura was terminated by clopidogrel administration. The generation of the migraine-like headache with visual aura is probably associated with microemboli due to endovascular coiling. This case supports the hypothesis that migraine with aura can be associated with microemboli of variant origins.
Highlights
AND IMPORTANCEMigraine-like headache, or symptomatic migraine, has often been reported to be caused by pathological alterations affecting migraine pain-related structures of the brain, such as brainstem and cerebral hemisphere [1,2,3]
The generation of the migraine-like headache with visual aura is probably associated with microemboli due to endovascular coiling
We report on a patient with Posterior cerebral artery (PCA) aneurysm who developed migraine-like headaches with visual aura after endovascular coiling treatment
Summary
Migraine-like headache, or symptomatic migraine, has often been reported to be caused by pathological alterations affecting migraine pain-related structures of the brain, such as brainstem and cerebral hemisphere [1,2,3]. We report on a patient with PCA aneurysm who developed migraine-like headaches with visual aura after endovascular coiling treatment. The patient was underwent DSA examination again, showing that the coil was stable and there was no in situ thrombus (Figures 2C,D) She experienced episodic visual disturbance and headache attacks similar to the episode on the day the antiplatelet agents were halted every month with a frequency of two times a month. Sixteen months after endovascular coiling treatment, the patient accepted EEG examination again in our department, and spike-and-slow wave complexes could be detected in the left occipital and temporal areas (Figure 3A). The patient reaccepted antiplatelet treatment with clopidogrel (75 mg/day), omitting valproate and aspirin, and her migraine-like headache with visual aura relieved during the 4 months of follow up. One month after the readministration with clopidogrel, EEG was reconducted, and neither epileptiform discharges nor asymmetric background activity was observed (Figure 3B)
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