Study of clinical profile and outcome of patients with migraine associated bleeds from a tertiary care centre in South India

Abstract

Headache is a common presenting symptom in day to day practice, so is epistaxis. Among different types of headaches, migraine is the most common type of headache. Although bleed from other sites are less common presentation compared to epistaxis. Often migraine and epistaxis are managed and evaluated as separate entity. Patients with such bleeds undergo extensive evaluation but do not arrive at definitive diagnosis. Here we present a subgroup of patients with migraine related bleeds from various sites which is less well recognised in day to day clinical practice and hence our study. Aim: To study the clinical profile and outcome in patients with migraine related bleeding. Materials and Methods: Study was conducted in a tertiary care hospital in South India. All patients with history of migraine and bleeding from different sites like nose, eyes, gums etc, presenting to out patient department where chosen for study and were subjected to a detailed questionnaire about same. Treatment was initiated accordingly and patient was followed up to look for treatment response and data was analysed under various variables. Results: These bleeds which was associated with migraine headache lasted only for few seconds to minutes. Beginning of bleeding and peak of severity of headache had no definite correlation. Termination of epistaxis (79%) and other bleeding sites was usually before termination of headache. Side of bleed varied, on side of headache 30%, bilateral or either side 35% and locked to one side in 35% of patients. 79% of patients responded well to Amitryptiline. Conclusion: Bleeds in migraineurs is not uncommon but is a under recognised entity. A detailed questionnaire regarding presence of migraine in patients presenting with epistaxis and bleeding from other sites, helps in avoiding unnecessary extensive evaluation of epistaxis. A significant relief from nose bleeds, gums and eyes is observed with optimum treatment of migraine. This also helps in impr