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[Coma associated with migraine]
I Requena1, B Indakoetxea, C Lema
1Departamento de Medicina, Complejo Hospitalario Universitario de Santiago de Compostela, España.
Introduction:
Basilar migraine is a particular form of migraine with an aura in which crises of headache are accompanied by symptoms of dysfunction in the vertebro-basilar territory, including alteration of consciousness in the form of stupor or coma.
Clinical Cases:
We report four patients, three men of 14, 17 and 83 years of age and one woman of 21. All had previous histories of migraine and presented with transitory episodes of coma. During the coma, the woman woke up spontaneously with intense bulimia. In the three men, it was seen, on injecting flumazenil, that the state of consciousness and the EEG returned to normal transiently. Neuroimaging studies (CT and MR) were normal in all patients.
Conclusions:
Migraine-coma is an exceptional, emergency condition in which structural, infectious, toxic and metabolic pathology of the Central Nervous System should be ruled out. As well as in patients with basilar migraine, the association of migraine and coma may also be seen in patients with familial hemiplegic migraine and CADASIL and MELAS syndromes. It may be that gabaergic mechanisms are involved in the theoretical dysfunction of the ascending reticular activating system causing alteration of consciousness, since in the three patients in whom flumazenil was injected, there was a response.
Insights
Basilar migraine can cause temporary coma, an emergency condition requiring immediate medical attention. Flumazenil showed transient recovery in some patients, suggesting potential GABAergic mechanisms.
Area of Science:
- Neurology
- Neuroscience
- Emergency Medicine
Background:
- Basilar migraine involves headache with vertebro-basilar dysfunction, potentially causing altered consciousness like stupor or coma.
- This case series explores migraine-induced coma, a rare but critical neurological event.
Purpose of the Study:
- To present clinical cases of patients experiencing coma associated with basilar migraine.
- To investigate potential mechanisms and diagnostic approaches for migraine-induced coma.
Main Methods:
- Case report of four patients (three male, one female) with a history of migraine presenting with transient coma.
- Administration of flumazenil to three male patients, observing effects on consciousness and EEG.
- Normal findings on CT and MRI neuroimaging in all participants.
Main Results:
- Patients experienced transient episodes of coma, with one exhibiting spontaneous awakening and bulimia.
- Flumazenil administration resulted in transient normalization of consciousness and EEG in three male patients.
- Neuroimaging studies were unremarkable, ruling out structural abnormalities.
Conclusions:
- Migraine-coma is an exceptional emergency necessitating exclusion of CNS pathologies (structural, infectious, toxic, metabolic).
- Association of migraine and coma can occur in basilar migraine, familial hemiplegic migraine, CADASIL, and MELAS syndromes.
- Flumazenil's transient efficacy suggests possible involvement of GABAergic mechanisms in the dysfunction of the ascending reticular activating system.