Stenting for coarctation of the aorta precipitating migraine with aura

The case of a 16-year-old girl with hypertension and coarctation of the aorta is presented. She underwent endovascular balloon dilation and stenting of the coarctation. Two days after this uncomplicated procedure, she started suffering from migraine with aura. Initially, the diagnosis of transient ischemic attacks was briefly considered, but extensive further assessment revealed no abnormalities. It is known that endovascular procedures, such as cerebral angiography or embolization of an intracranial vascular malformation, can induce migraine. To our knowledge, this is the first report of migraine with aura precipitated by an extracranial endovascular procedure: stenting for coarctation of the aorta. Series on both short-term results and long-term outcome of endovascular management of aortic coarctation have never reported migraine as a complication. Although the mechanism responsible for the onset of migraine in our patient remains unclear, it is conceivable that there was a relative intracranial hypertension before and a relative hypotension leading to hypoperfusion after dilation of the aorta. This acute disturbance of the cerebral hemodynamic balance may have set off the neurovascular mechanism leading to migraine attacks with aura.