COMPLICATED MIGRAINE

Migraine is a chronic paroxysmal neurological disease characterized by attacks of moderate or severe headache accompanied by reversible neurologic and systemic symptoms. Although not life threatening, migraine can cause disability in the productive population. Migraine sufferers generally have a family history of migraine so that migraine is considered a genetic disease. Endogenous psychological factors such as stress or fatigue are the main triggers for migraine. Migraine pathophysiology involves various parts of the brain so that migraine symptoms are complex. Management of acute migraine can be done pharmacologically and non-pharmacologically. Migraine preventive management is needed if the patient has a chronic migraine or does not respond to abortive treatment.

Analysis of hospitalizations for complicated migraine in northeastern Brazil between 2010 and 2020

Background: Migraine is characterized as a strong migraine attack with aura, presenting signs and symptoms such as nausea and vomiting, and when intensified and out of control it is called complicated migraine (CM). In addition, CM causes biopsychosocial problems to the patient, causing difficulties or inability to perform functions, such as work, among others. Objectives: To analyze the number of hospitalizations for CM in northeastern Brazil from 2010 to 2020. Design and setting: Cross-sectional, descriptive and observational epidemiological study conducted in the city of São Luís (MA), Brazil. Methods: The source of the data was the Authorizations for Hospital Admission by CM, in northeastern Brazil, between January 2010 and December 2020, by the DATASUS system, using the keywords “treatment of complicated migraine”. Results: The northeast region showed a total of 12,602 hospitalizations for CM treatment, with the state of Maranhão accounting for most hospitalizations (3323). In the northeast, the year 2019 showed the highest prevalence (2260), while the year 2010 showed the lowest prevalence (517). Moreover, in the northeast region there was a total expenditure of 525,428.01 dollars on hospital services. The state of Pernambuco spent the most on hospital services for the treatment of CM (168,934.85 dollars). Conclusion: In this study, the northeastern region presented a significant increase in the cases of CM in the period studied. In addition, the state of Maranhão was the most affected by CM and the state of Pernambuco generated most of the expenses for the treatment of this pathology.

Case Report: Migrainous Infarct without Aura

Background: Stroke in a migraine with aura has been documented in several cases, even deserving the merit of a classification as complicated migraine. Herein, we present a rare case of migrainous infarct without aura. The diagnosis was challenging due to lack of risk factors. The patient was unique in not having any other comorbidities. Case Presentation: The case is of a 21-year-old female presenting with right-sided hemiplegia and facial drooping. She had had an index presentation of throbbing headaches for the past 2 years, typical of a migraine but not preceded by any aura symptoms. However, in the current episode, the pain became excessively severe and accompanied by right-sided hemiplegia and facial drooping. A full investigation workup using MRI revealed evidence of infarct in the left temporoparietal and basal ganglion region. Conclusion: Our case highlights the need to evaluate silent ischemic stroke in case of prolonged headache with a history of migraine as well as the need for precaution to avoid the use of triptans or opioids in such a case. It also highlights the conditions that need to be excluded before labeling it as a migrainous infarct.

Aphasic Dystextia as Presenting Feature of Ischemic Stroke in a Pediatric Patient

Aphasia is an important presenting symptom of acute stroke. With increasing reliance on electronic communication, incoherent texting or “dystextia,” which is a subset of aphasia that is reflected in text messages, can be a useful tool for symptom recognition and analysis. It can be a red flag for the family and therefore can help in early identification of an acute neurological deficit. It is also useful for providers to reliably analyze the deficit as well as establish a timeline of evolution of symptoms. There have been case reports where dystextia has been the presenting feature of stroke or complicated migraine and in one case of meningioma. We present the case of a teenage patient that in our knowledge is the youngest reported case of dystextia, whose aphasia recorded in a text message assisted with stroke localization. This also adds to the literature of dystextia which so far has only seven other cases reported.