Acephalgic Migraine Presenting as Episodic Fatigue and Nausea: A Case Report

Area of Science:

• Neurology
• Neuroscience
• Clinical Medicine

Background:

• Acephalgic migraine (AM), or migraine aura without headache, is a challenging subtype of migraine.
• AM diagnosis is complicated by varied presentations and potential misattribution to other disorders.

Purpose of the Study:

• To describe a case of acephalgic migraine presenting with atypical symptoms.
• To emphasize the diagnostic challenges and importance of clinical reasoning in identifying AM.

Main Methods:

• Case report of a 38-year-old female with episodic fatigue, nausea, and cognitive dysfunction.
• Diagnostic workup included medication trials (ondansetron, metoclopramide) and detailed patient history.
• Therapeutic trial with triptans was used to confirm the diagnosis.

Main Results:

• Initial workup was inconclusive, with partial relief from ondansetron but not metoclopramide.
• Family history and identified triggers (dietary, hormonal) supported a migraine diagnosis.
• Triptan therapy led to dramatic symptom resolution, confirming acephalgic migraine.

Conclusions:

• This case highlights the diagnostic difficulties of AM and migraine aura variants.
• Thorough patient history, communication, and clinical reasoning are crucial for diagnosing atypical migraine presentations.
• Increased clinician awareness of the migraine spectrum is vital for accurate diagnosis and improved patient outcomes.