Not just any headache

A 40-year-old man with a history of traumatic retinal detachment in the left eye treated with scleral buckle and migraine with aura presented to clinic for persistent blurry vision of the right eye following an episode of migraine with aura. The patient had experienced migraines with visual auras starting as a teenager, which normally resolve within an hour except for the most recent episode. Humphrey visual field showed right superior homonymous quadrantanopia. Computed tomography of the head without contrast showed acute ischemia in the left occipital lobe. Magnetic resonance imaging of the brain confirmed an ischemic infarct of the left occipital lobe. There were no significant abnormalities in complete blood count, metabolic panel, coagulation studies, and infectious testing. Echocardiogram and transthoracic echocardiography were normal as well, but further work up by cardiology revealed a patent foramen ovale on transesophageal echocardiogram. This case illustrates a rare case of migrainous infarction, which should be considered as a possible complication of migraine with aura, presenting with persistent visual changes.