Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Triptan-responsive migraine-like headache caused by cavernous sinus dural arteriovenous fistula in a 69-year-old woman with a history of migraine without aura

Mika Saiki, M.D.1), Keisuke Suzuki, M.D., Ph.D.1), Hidehiro Takekawa, M.D., Ph.D.1)2), Hideaki Kanaya, M.D., PhD.3), Shunsuke Kawamoto, M.D., Ph.D.3), Toshiki Nakamura, M.D., Ph.D.4) and Koichi Hirata, M.D., Ph.D.1)

1)Department of Neurology, Dokkyo Medical University
2)Center of Medical Ultrasonics, Dokkyo Medical University Hospital
3)Department of Neurosurgery, Dokkyo Medical University
4)Department of Neurology, Rehabilitation Amakusa Hospital

A 69-year-old woman with a previous history of migraine without aura developed throbbing headache in the right frontal region accompanied by nausea, lasting more than 4 hours a day. The headache intensity was more severe than that of usual her migraine headaches. Administration of eletriptan in the previous hospital improved her headaches. However, one month later the patient experienced more intense headaches in the same region and then was referred to our hospital. MR angiography showed abnormal signal intensities in the cavernous sinus. Cerebral angiography revealed blood reflux to the cavernous sinus, leading to diagnosis of cavernous sinus dural arteriovenous fistula. Transvenous embolization of cavernous sinus dural arteriovenous fistula was performed, which resulted in resolution of the patient's headache. We should be aware that patients with cavernous sinus dural arteriovenous fistula can manifest migraine-like headaches without being accompanied by cranial nerve palsies.
Full Text of this Article in Japanese PDF (433K)

(CLINICA NEUROL, 58: 188|192, 2018)
key words: cavernous sinus dural arteriovenous fistula, triptan, migraine

(Received: 27-Oct-17)