Volume: 43 Issue: Supplementary 1
Year: 2023, Page: 243-246, Doi: https://doi.org/10.51248/.v43i1.2579
Studies about headaches associated with acute ischemic stroke in patients suffering from migraine were limited, and therefore we present a clinical case of central post-stroke pain (CPSP) in a 47-year-old woman with migraine and lacunar infarcts in the medulla oblongata and also possible mechanisms of CPSP in patients with migraine. Magnetic resonance imaging of the brain revealed lacunar infarction in the medulla oblongata on the right (vertebral artery basin) and a single focus of gliosis in the parietal lobe on the right. Magnetic resonance angiography of cerebral vessels showed the fetal type of structure of both posterior cerebral arteries. This clinical case is a complex clinical situation of a combination of secondary headaches (post-stroke) in a patient with a primary headache (migraine), which was successfully treated by the combined administration of first-line drugs for the treatment of neuropathic pain in a patient with lacunar infarcts in the medulla oblongata. The treatment of CPSP is a difficult task due to the insufficiently unexplored mechanisms of development, the most effective approaches are those aimed at reducing the increased excitability of neurons.
Keywords: Migraine; acute ischemic stroke; central post-stroke pain; lacunar infarcts; medulla oblongata
1. Silberstein, S. D. Migraine. Lancet. 2004;363(9406):381-391.
2. Donnan, G. A., Fisher, M., Macleod, M., Davis, S. M. Stroke. Lancet. 2008;371(9624):1612-1623.
3. Schürks, M., Kurth, T. Is migraine a predictor for identifying patients at risk of stroke? Expert Rev Neurother. 2011;11(5):615-618.
4. Vityala, Y., Mamytova, E., Turgumbaev, D., Kadyrova, A., Toktomametova, A., Zholdoshev, E., et al., Clinical features of acute ischemic stroke in moderately and severely ill patients with coronavirus disease 2019 (COVID-19). Biomedicine. 2021;41(2):397-400.
5. Mamytova, E., Kadyrova, A., Turgumbaev, D., Zholdoshev, E., Vityala, Y., Tagaev, T., et al., Risk factors of ischemic stroke/transient ischemic attack in young women: A case report. Biomedicine. 2021;41(1):160-162.
6. GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol. 2017; 16(11):877-897.
7. Mamytov, M., Mamytova, E., Toktomametova, A., Miklukhin, D., Yethindra, V., Tagaev, T., et al., Expression of autophagy and apoptosis biomarkers in patients with acute ischemic stroke. Biomedicine. 2022;42(5):988-991.
8. Granella, F., Sances, G., Pucci, E., Nappi, R. E., Ghiotto, N., Napp, G. Migraine with aura and reproductive life events: a case control study. Cephalalgia. 2000; 20(8):701-707.
9. Frigerio, R., Santoro, P., Ferrarese, C., Agostoni, E. Migrainous cerebral infarction: case reports. Neurol Sci. 2004;25 Suppl 3: SS300-SS301.
10. Chang, C. L., Donaghy, M., Poulter, N. Migraine and stroke in young women: case-control study. The World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. BMJ. 1999;318(7175):13-18.
11. Merikangas, K. R. Contributions of epidemiology to our understanding of migraine. Headache. 2013;53(2):230-246.
12. Kristensen, B., Malm, J., Carlberg, B., Stegmayr, B., Backman, C., Fagerlund, M., et al., Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in northern Sweden. Stroke. 1997;28(9):1702-1709.
13. Díez-Tejedor, E., del Brutto, O., Alvarez Sabín, J., Muñoz, M., Abiusi, G. Classification of cerebrovascular diseases. Iberoamerican Cerebrovascular Diseases Society. Rev Neurol. 2001;33(5):455-464.
14. Mahmoud, A. N., Mentias, A., Elgendy, A. Y., Qazi, A., Barakat, A. F., Saad, M., et al., Migraine and the risk of cardiovascular and cerebrovascular events: a meta-analysis of 16 cohort studies including 1 152 407 subjects. BMJ Open. 2018;8(3): e020498
15. Lebedeva, E. R., Gurary, N. M., Olesen, J. New diagnostic criteria for headache attributed to transient ischemic attacks. J Headache Pain. 2019; 20(1):97.
16. Noseda, R., Melo-Carrillo, A., Nir, R. R., Strassman, A. M., Burstein, R. Non-trigeminal nociceptive innervation of the posterior dura: implications to occipital headache. 2019; 39(10):1867-1880.
17. Haubrich, C., Wendt, A., Diehl, R. R., Klotzsch, C. Dynamic autoregulation testing in the posterior cerebral artery. Stroke. 2004; 35(4):848-852.
18. Davis, C., Reno, E., Maa, E., Roach, R. History of migraine predicts headache at high altitude. High Alt Med Biol. 2016;17(4):300-304.
19. Burtscher, M., Mairer, K., Wille, M. Risk factors for high-altitude headache in mountaineers. Cephalalgia. 2011; 31:706-711.
20. Schoonman, G. G., Sandor, P. S., Agosti, R. M. Normobaric hypoxia and nitroglycerin as trigger factors for migraine. Cephalalgia. 2006; 26:816-819.
21. Linde, M., Edvinsson, L., Manandhar, K., Risal, A., Steiner, T. J. Migraine associated with altitude: results from a population-based study in Nepal. Eur J Neurol. 2017;24(8):1055-1061.
Elmira Mamytova, Mitalip Mamytov, Kunduz Karbozova, Asel Jusupova, Begimai Kadyrova, Aiperi Toychueva, Alina Atabekova, Yethindra Vityala, Tugolbai Tagaev. rare case of central post-stroke pain in a patient with migraine and lacunar infarcts in the medulla oblongata. Biomedicine: 2023; 43(1) Supplementary issue: 243-246