Migraine with brainstem aura presenting as recurrent hypersomnia (Kleine-Levin syndrome)

Abstract

Recurrent hypersomnia, or Kleine-Levin syndrome, is rare and frequently causes substantial diagnostic anxiety and delay. Patients often undergo multiple investigations to rule out other causes of encephalopathy. The treatment options are unsatisfactory. Migraine with brainstem aura has not previously been widely considered in the medical literature as a differential diagnosis. We describe two patients referred to a tertiary sleep neurology service with a putative diagnosis of Kleine-Levin syndrome. Each described attacks of hypersomnia with elements of migraine with brainstem aura, in addition to having a history of migraine with aura. Simple acute migraine treatment clearly attenuated further attacks. These cases generate discussion as to the common features and potential mechanisms underlying both disorders. Furthermore, they highlight a hitherto underexplored alternative diagnosis of Kleine-Levin syndrome. This provides scope for offering established and effective migraine treatment options to patients who with a potential misdiagnosis of Kleine-Levin syndrome, providing scope for offering established and effective migraine treatment to some patients originally diagnosed with a rare condition for which there is no current consistently effective therapeutic options.

Basilar-type migraine: An overlooked cause of loss of consciousness in pediatric emergency rooms

“…We hope to provide a scope for offering effective migraine treatment to patients who were originally diagnosed as having a rare condition and received ineffective treatment. 4…”

Migraine with Brainstem Aura Accompanied by Disorders of Consciousness

“…In this review, we used PubMed, Scopus, Web of Science, and Google Scholar to collect case reports of migraine with DOC from 1961 to 2020 (Table 1). [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] To improve the recall ratio of the literature, we used different search terms besides "migraine with brainstem aura" (including previously used terms: "basilar artery migraine", "basilar migraine", or "basilartype migraine"). Then, we review the relevant literature to further determine whether there was a MBA with DOC.…”

“…Migraine with brainstem aura (MBA) is a rare migraine subtype [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] and accounts for about 1.5% of headache and 6.6-10% of migraine with aura. 16,17 The aura features include vertigo, dysarthria, diplopia, tinnitus, ataxia, and disorders of consciousness (DOC).…”

“…Previously Diagnosed MBA with DOC Cases , while others can relieve headache symptoms by vomiting1,3,4 or sleeping 12,13,37. Diagnostic ToolsRoutine blood tests and cerebrospinal fluid tests for MBA with DOC patients yield normal results,1,[3][4][5][6][7][8][9][10][11][12][13][14][15][37][38][39] except for a single case that reported elevated blood ammonia.…”