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We report two patients with migraine who experienced migrainous aura-like symptoms several minutes after the onset of acute headache induced by subarachnoid hemorrhage (SAH). The cases suggest that SAH is a trigger for migrainous aura.
Patient 1.
A 39-year old woman acutely developed nausea and severe bilateral headache, rising from the neck to the forehead. Ten minutes later, she experienced visual migrainous aura-like symptoms slowly propagating into one visual hemifield. The scintillation scotoma resolved after ∼25 minutes. The patient had a 15-year history of migraine according to International Headache Society (IHS) criteria. She recalled at least one scintillation scotoma followed but not preceded by headache several months before admission.
Examination revealed moderate neck stiffness (World Federation of Neurological Surgeons [WFNS] grade 1). CT scanning demonstrated a Fisher grade 3 SAH (figure,A). Angiography depicted an aneurysm of the anterior communicating artery (see the figure,B). The aneurysm was clipped 15 hours after bleeding.
Figure. (A) CT scan on admission shows massive subarachnoid hemorrhage (SAH). (B) Initial right carotid arteriogram, oblique …
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