1. 純月經偏頭痛合併感覺預兆- 一個案報導
Pure Menstrual Migraine with Sensory Aura- One Case Report
陳建志1 許永居2
1行政院衛生署雙和醫院 放射科
2戴德森醫療財團法人嘉義基督教醫院 神經內科
Jiann-Jy Chen 1 Yung-Chu Hsu 2
1 Department of Medical Imaging, Taipei Medical University & Shuang Ho Hospital, New Taipei, Taiwan
2 Department of Neurology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
Purpose
TABLE 1 Diagnostic criteria of menstrual migraine
Pure menstrual migraine
Attacks, in a menstruating woman, fulfilling criteria for migraine without aura
Attacks occur exclusively on day 1±2 (i.e. days -2 to +3) 1 of menstruation in at least two out of three menstrual cycles and at no other times of the cycle
Menstrually-related migraine
Attacks occur on day 1±2 (i.e. days -2 to +3) of menstruation in at least two out of three menstrual cycles and additionally at other times of the cycle
Hormonal changes, particularly related to the menstrual cycle, can impact migraine in women. Menstrual migraine attacks are almost invariably without aura. Thus menstrual or non-menstural migraines have been one way to stratify migraine without aura according to the criteria of International Classification of Headache Disorders (Table 1). Pure menstrual migraine with aura rarely occurred. We present a peri-menopausal woman whose sensory aura exclusively heralded her pure
menstrual migraine.
TABLE 2 Characteristics of headache before and after menopause
Case Report
Headache pattern
Peri-menopause
Post-menopause
Premonitory symptom
Abdominal fullness, poor appetite No
Aura
Sensory aura in left upper limb
Description
Holocranial, throbbing, motion intolerance
Holocranial, dull and less severe
Associated symptom
Photophobia, nausea
Photophobia
Severity
Moderate
Duration
6 hours
0.5–2 hours
Interval
1 month exactly
Diagnosis
Typical aura with migraine headache
“Tension-type headache” like
A 51-year-old woman had suffered from monthly episodic headaches since age 46. Before headache started, she always experienced numbness on her whole left upper limb within one hour on the first menstrual day. After her sensory aura remitted, migrainous headache accompanied by nausea and photophobia ensued. In the postmenopausal period, she did not have sensory aura any more, but her headache pattern changed and became less severe (Table 2). After she received brain magnetic resonance imaging and conventional angiography studies (Fig 1), we established the diagnosis of pure menstrual
migraine with sensory aura.
Fig. 1 Brain MRI (Fig 1-A) and Conventional digital subtraction
angiography (Fig 1-B) showed normal results.
Conclusion
Menstrual migraine, including pure menstrual migraine and menstrually-related migraine, tends to be associated more with migraine without aura.. To our knowledge, this is the first formal case report about pure menstrual migraine with aura. Further study is worthy of investigating which features of menstrual
migraine are more associated with aura.