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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.

Revista De Neurologia
|January 19, 2000
PubMed
Summary
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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.

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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.