Chronic Migraine-Like Headache Caused by a Demyelinating Lesion in the Brain Stem

Abstract

To the Editor: The term “chronic migraine” officially appeared for the first time in the International Classification of Headache Disorders, 2nd Edition criteria (ICHD-II) [1]. Now, the 2006 revised diagnostic criteria for chronic migraine [2] are preferred to the official 2004 ICHD-II criteria [1]. Clinically isolated syndrome (CIS) has been defined as a single neurological episode at first presentation with suspected underlying inflammatory demyelinating disease [3]. Headache associated with demyelinating lesions is characterized by clinical features that, in most cases, meet the ICHD-II criteria [1] for tension headache or migraine. Because these headaches cannot be regarded, by definition, as “primary,” they are commonly defined as “tension-like headaches” or “migraine-like headaches.” Here, we describe the case of a 16-year-old girl who showed the onset of chronic migraine-like headache in association with the appearance of a T2-hyperintense lesion localized in the right dorsolateral pons and the right middle cerebellar peduncle (MCP). On March 2, 2009, the girl came to our attention for a recent progressive worsening of a 5-month history of right-sided nuchal-occipital throbbing headache, nausea, vomiting, and drowsiness. Two days before, she had developed hypoesthesia in the region of the second branch of the trigeminal nerve on the right side. Her past medical history was significant for a migraine without aura [1] …