Department of Neurology, Medical Faculty of Karadeniz Technical University, 61080 Trabzon, Turkey.
Neurol Sci. 2012 Feb;33(1):125-8. doi: 10.1007/s10072-011-0651-z. Epub 2011 Jun 17.
Headache is a common symptom at the onset of acute ischemic cerebrovascular disease. Simultaneous development of migraine-like headache and stroke in the same patient makes it difficult to differentiate between migraine-induced stroke and migraine-like headache attributed to ischemic stroke. We report a case of a 34-year-old woman with no previous migraine history who presented with migraine-like headache, thought to be a first attack of migraine, and who developed brainstem infarction shortly after triptan administration. Magnetic resonance imaging revealed an acute pontine infarction, and CT angiography revealed occlusion of the basilar artery. A detailed etiological evaluation revealed no risk factor for ischemic stroke. We believe that the migraine-like headache was the first symptom of cerebral ischemia and that sumatriptan accelerated the development of the infarction. This case report emphasizes the importance of accurate diagnosis of migraine before using triptans. Secondary causes of migraine-like headache should be excluded, especially in patients with migraine-like headache for the first time.
头痛是急性缺血性脑血管病发病时的常见症状。同一患者同时出现偏头痛样头痛和卒中，使得偏头痛性卒中与归因于缺血性卒中的偏头痛样头痛之间的鉴别变得困难。我们报告了一例 34 岁女性病例，该患者既往无偏头痛病史，表现为偏头痛样头痛，初诊为偏头痛发作，在使用曲坦类药物后不久即发生脑干梗死。磁共振成像显示急性脑桥梗死，CT 血管造影显示基底动脉闭塞。详细病因评估未发现缺血性卒中的危险因素。我们认为偏头痛样头痛是脑缺血的首发症状，而舒马曲坦加速了梗死的发展。本病例报告强调了在使用曲坦类药物之前准确诊断偏头痛的重要性。应排除偏头痛样头痛的继发性病因，特别是对于首次出现偏头痛样头痛的患者。
