Migraine and epistaxis: An interesting combination

This is the report of a 28 year old woman who had a holocranial pulsating headache once a month with nausea, photophobia and phonophobia lasting about 48 hours. There was no preceding aura. The headache used to subside on every occasion with profuse epistaxis from both nostrils. Her neurological and otolaryngological examination was normal. MRI brain showed no abnormality. During one of the examinations at the time of the headache and epistaxis, she was found to have bilateral congestion of nasal mucosa with no obvious identifi cation of bleeding points. This case illustrates that migraine can result in epistaxis in some patients. Neurology Asia 2012; 17(2) : 153 – 154 Address correspondence to: Dr Sweta Adatia MBBS; MD; DNB(Neurology), Department of Neurology, Lilavati Hospital and Research Center, Mumbai. 400050 India. CASE REORT We report the case of a 28 year old patient with migraine. She was referred to the neurology service for a holocranial pulsating headache approximately once a month with nausea, photophobia and phonophobia lasting about 48 hours. There was no relation to menstruation. However, the headaches became worse with exertion. There was no preceding aura. The headaches used to subside with an attack of profuse epistaxis from both nostrils on every occasion. The patient did not take any triptans or nonsteroidal antiinfl ammatory drugs (NSAIDS). The headache subsided with paracetamol and domperidone. Her general examination and neurological examination was normal. The patient underwent a complete otolaryngological examination by an ENT surgeon to rule out an obvious cause of bleeding. During one of the examinations at the time of the headache and epistaxis, she was found to have congested mucosa bilaterally without obvious bleeding points identifi ed. At a repeat examination 12 hours after her headache had subsided, her nasal mucosa looked normal. She underwent tests for coagulation disorders as well as an MRI brain. All investigations were found to be normal. Her grandmother also suffered similar headaches with epistaxis in her youth. However no cause of epistaxis was found in her as well.