Nutcracker syndrome mimicking new daily persistent headache: A case report.

Area of Science:

• Vascular Surgery
• Neurology
• Gastroenterology

Background:

• Aortomesenteric compression (AMC) involves the entrapment of the duodenum and left renal vein between the aorta and superior mesenteric artery.
• AMC typically presents with symptoms of bowel obstruction or hematuria, with headaches being a rare manifestation.

Observation:

• A young woman experienced new daily persistent headache (NDPH) refractory to multiple treatments.
• She also developed worsening abdominal pain and food intolerance, leading to the diagnosis of AMC.
• Surgical decompression for AMC resulted in significant improvement of both gastrointestinal symptoms and the intractable headaches.

Findings:

• This case represents the first documented instance of NDPH associated with AMC.
• The resolution of severe headaches following surgical decompression highlights a potential causal link.
• It suggests that AMC should be considered in the differential diagnosis of refractory NDPH, particularly with concurrent gastrointestinal symptoms.

Implications:

• AMC is an underrecognized cause of new daily persistent headaches.
• Surgical intervention for AMC can effectively treat associated neurological and gastrointestinal symptoms.
• This case broadens the understanding of AMC's clinical presentation and treatment outcomes.