Migraine and Intracerebral Hemorrhage

Abstract

To the Editor. —Intracerebral hemorrhage in migrainous patients has only rarely been reported.1-7Cole and Aube8recently described three women with lobar intracerebral hemorrhage either during or immediately following typical migraine attacks. The patients did not have evidence of underlying conditions predisposing to intracerebral hemorrhage. The authors suggested vasospasm with necrosis of the vessel wall followed by sudden reperfusion as the cause of rupture of ischemic vessels, resulting in hemorrhage. Clinically, they observed that a migraine attack associated with bleeding was similar to the patient's usual headaches, but somewhat more severe and prolonged. Furthermore, in two patients carotidynia was observed. We previously described 11 migrainous patients with intracerebral hemorrhage associated with migraine attacks.9All of the patients were diagnosed by computed tomographic scan and studied by carotid angiography, cranial magnetic resonance imaging, or both. The mean age was 35.8 years (range, 19 to 48 years). Nine subjects