Recurrent Syncope During Migraine Attacks

Area of Science:

• Neurology
• Cardiology

Background:

• Migraine attacks involve headaches, sensory intolerance, and nausea/vomiting.
• Loss of consciousness during migraine is often linked to pain reflexes, but autonomic impairment and cardiac issues are also implicated.

Purpose of the Study:

• To investigate the cause of syncope in a patient experiencing episodes exclusively after vomiting during migraine attacks.
• To highlight the importance of investigating syncope during migraine beyond attributing it to pain.

Main Methods:

• Case report of a 51-year-old woman with syncope linked to migraine and vomiting.
• 24-hour Holter monitoring during a migraine attack to assess cardiac function.
• Pacemaker implantation following diagnosis of intermittent complete atrioventricular block.

Main Results:

• Syncope episodes were exclusively associated with vomiting during migraine attacks.
• Holter monitoring revealed an intermittent complete atrioventricular block coinciding with syncope.
• Pacemaker implantation successfully prevented further syncopal episodes.

Conclusions:

• Syncope during migraine attacks can be due to cardiac conduction abnormalities, such as atrioventricular block.
• Clinical suspicion and investigation are crucial for syncope occurring during migraine to avoid misdiagnosis.
• Attributing syncope solely to pain may delay diagnosis and treatment of underlying cardiac causes.