Epistaxis Accompanying Migraine Attacks

Durán-Ferreras, Eduardo; Viguera, J.; Patrignani, Giorgio; Martínez-Parra, Carlos

doi:10.1111/j.1468-2982.2007.01370.x

Cited by 10 publications

(10 citation statements)

References 7 publications

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“…Epistaxis appeared between the peak severity of headache and the beginning of its resolution, similar to previous descriptions [5, 6]. Therefore, it could be considered as a symptom of the resolution phase of migraine.…”

Section: Discussionsupporting

confidence: 85%

“…This chronological profile is consistent with one of the classical concepts of the resolution of migraine (lytic state or resolution by secretion) which may include vomiting, diuresis, lacrimation, sweating or epistaxis [1]. Co-occurrence of a throbbing headache and epistaxis could be due to the activation of the trigeminovascular system, causing vasodilation of dependent branches of the internal and external carotid arteries [6]. However, this attractive hypothesis presents an epidemiological weakness: migraine is common but descriptions of migraine with epistaxis are rare.…”

Section: Discussionsupporting

confidence: 79%

“…Topiramate, prescribed worldwide for migraine prophylaxis, may trigger violent nose bleeding [4]. Despite all these observations, only two cases of epistaxis associated with migraine without aura were described [5, 6]. …”

Section: Introductionmentioning

confidence: 99%

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Migraine-Induced Epistaxis and Sporadic Hemiplegic Migraine: Unusual Features in the Same Patient

et al. 2012

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Background: Since the mid-19th century, epistaxis and migraine have been occasionally associated with each other. Nevertheless, we found only two cases in the contemporary medical literature. Sporadic hemiplegic migraine is a subtype of migraine with reversible motor deficits, without similar episodes in relatives. Case: We describe a 47-year-old male with a history of migraine with a scintillating scotoma starting at the age of 20. In some of the episodes, he developed epistaxis in the resolution phase of migraine. At the age of 35, he experienced a visual aura followed by transient aphasia, left crural weakness and headache. Contralateral similar episodes occurred in the subsequent months. Neurological examination and MRI were normal. Mutations in CACNA1A, ATP1A2, SCN1A and NOTCH3 were excluded. Discussion: Three distinct aspects deserve our consideration. This is the first report of migraine-induced epistaxis involving aura; the scarcity of similar reports may be due to the lack of a guided anamnesis. The complex aura presented had a peculiar topography, inconsistent with the classical analytical neurological semiology. This may suggest that the spreading depression affects the brain bilaterally but in an uneven and elective manner. Lastly, the present report conveys that the late appearance of complex auras requires improbable interactions between environmental and endogenous conditions in individuals with a genetic predisposition.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 79%

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Migraine-Induced Epistaxis and Sporadic Hemiplegic Migraine: Unusual Features in the Same Patient

et al. 2012

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“…Earlier studies considered epistaxis to be part of resolution phase something similar to vomiting or diuresis or sweating in migraine. [5][6][7] But in our study majority of patients didn't corelate exactly with resolution phase . Both Males and Females had equal preponderance, and none of the female subjects had menorrhagia unlike other studies.…”

Section: Discussioncontrasting

confidence: 66%

Study of clinical profile and outcome of patients with migraine associated bleeds from a tertiary care centre in South India

Awati¹

2020

IJN

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Headache is a common presenting symptom in day to day practice, so is epistaxis. Among different types of headaches, migraine is the most common type of headache. Although bleed from other sites are less common presentation compared to epistaxis. Often migraine and epistaxis are managed and evaluated as separate entity. Patients with such bleeds undergo extensive evaluation but do not arrive at definitive diagnosis. Here we present a subgroup of patients with migraine related bleeds from various sites which is less well recognised in day to day clinical practice and hence our study. Aim: To study the clinical profile and outcome in patients with migraine related bleeding. Materials and Methods: Study was conducted in a tertiary care hospital in South India. All patients with history of migraine and bleeding from different sites like nose, eyes, gums etc, presenting to out patient department where chosen for study and were subjected to a detailed questionnaire about same. Treatment was initiated accordingly and patient was followed up to look for treatment response and data was analysed under various variables. Results: These bleeds which was associated with migraine headache lasted only for few seconds to minutes. Beginning of bleeding and peak of severity of headache had no definite correlation. Termination of epistaxis (79%) and other bleeding sites was usually before termination of headache. Side of bleed varied, on side of headache 30%, bilateral or either side 35% and locked to one side in 35% of patients. 79% of patients responded well to Amitryptiline. Conclusion: Bleeds in migraineurs is not uncommon but is a under recognised entity. A detailed questionnaire regarding presence of migraine in patients presenting with epistaxis and bleeding from other sites, helps in avoiding unnecessary extensive evaluation of epistaxis. A significant relief from nose bleeds, gums and eyes is observed with optimum treatment of migraine. This also helps in improving the quality of life of our patients and reduces the apprehension of nose bleeds, social embarassment and syncopal attacks secondary to blood sight.

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“…Some migraine-related conditions such as migraine associated blackout or fainting, seizure-like episode, or chest pain are conspicuously absent from the classification. Additionally, it is not unusual in children with migraine to present with isolated leg, body (corpalgia), or lower back pain, and nose bleed [6,7].…”

Section: Classificationmentioning

confidence: 96%