[Delayed Diagnosis of Primary Sjögren's Syndrome presenting as Atypical Migraine - A Case Report]

Primary Sjögren's Syndrome usually presents with Sicca symptoms but may initially manifest with non-specific neurological complaints such as migraine, paresthesia or dizziness.

A 34-year-old woman reported recurrent headaches, dizziness, and a single episode of mild aphasia; she was initially diagnosed with migraine without aura. Despite stage-appropriate therapy, additional symptoms such as dry mouth and eyes as well as arthralgia developed.

Cranial imaging was unremarkable. Orbital Doppler sonography revealed widened optic nerve sheaths. Autoimmune serology was positive for ANA, ENA, and Anti-SSA antibodies. Schirmer test, tear film break-up time, and salivary flow confirmed sicca syndrome.

After diagnosis, treatment with prednisolone and hydroxychloroquine was initiated, leading to a significant improvement in neurological and extraglandular symptoms. Pilocarpine along with supportive eye and oral care improved the sicca symptoms.

Non-specific neurological symptoms may represent early in Primary Sjögren's Syndrome, highlighting the importance of early serological testing and interdisciplinary evaluation.