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Published on: June 2, 2014
The Intersection of Migraine and Epistaxis: Clinical Observations and Analysis
Shalesh Rohatgi1, Salil Gundewar1, Satish Nirhale1
1Department of Neurology, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND.
Abstract:
Migraine prevalence has risen over the last few decades, which may be attributed to lifestyle changes. Epistaxis is unusual in migraine. Here we present a case series of four patients, who are presented with headaches associated with epistaxis. A detailed history revealed cardinal symptoms of migraine according to the International Headache Society, including hemicranial throbbing headache of moderate to severe intensity lasting for a duration of four to 72 hours, along with associated features of nausea, vomiting, photophobia, and phonophobia. Investigations, including ENT (ear, nose, and throat) examination, nasal endoscopy, gastroscopy, bronchoscopy, hematological, and coagulation parameters, were negative. All patients were started on prophylactic treatment for migraine, and they responded well. Epistaxis occurs at the peak of headache following which symptoms tend to resolve. The pathophysiology behind this is stimulation of the trigeminovascular system leading to dilatation of external and internal carotid arteries.
Insights
Migraine headaches accompanied by epistaxis (nosebleeds) were observed in four patients. These cases suggest a potential link between migraine and nosebleeds, with symptoms resolving after prophylactic migraine treatment.
Area of Science:
- Neurology
- Otolaryngology
Background:
- Migraine prevalence is increasing, potentially due to lifestyle factors.
- Epistaxis is an uncommon symptom associated with migraine.
Observation:
- A case series of four patients presented with headaches and epistaxis.
- Patients exhibited cardinal migraine symptoms: hemicranial, throbbing, moderate-to-severe intensity, 4-72 hours duration, with nausea, vomiting, photophobia, and phonophobia.
- Investigations including ENT exams and blood tests were unremarkable.
Findings:
- All patients responded well to prophylactic migraine treatment.
- Epistaxis occurred at the headache peak and preceded symptom resolution.
- The trigeminovascular system stimulation and carotid artery dilatation are hypothesized pathophysiological mechanisms.
Implications:
- This case series highlights an unusual presentation of migraine with epistaxis.
- Understanding this association may improve diagnosis and management of migraine patients experiencing nosebleeds.
- Further research is warranted to elucidate the pathophysiology linking migraine and epistaxis.
