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To the Editor:
Linetsky et al.1 report an interesting observation regarding six patients with migrainous stroke whose headache severity and frequency improved following stroke. The putative mechanism was a loss of vasoreactivity of the affected cerebral blood vessel (to vasodilator substances), as determined by breath holding index (BHI), resulting in reduced nocipetive transmission. The significance of reduced blood flow measured by BHI is unclear in migraine, as it has been reported with carotid stenosis (without apparent headache), in migraineurs between attacks, and also as generalized phenomenon during attacks of unilateral migraine without aura.2,3⇓ We report a similar patient and propose that these patients provide support for a direct effect on cortex as the reason for improvement in migraine.
A 53-year-old man had a 20-year history of bilateral migraine headaches lasting 6–8 hours at a frequency of 2–3 months. A prodrome of sudden fatigue and generalized nonspecific discomfort preceded the headaches. His …
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