Migrainous Stroke: When Headache Presents with Persistent Visual Symptoms

Migrainous infarction is a rare complication of migraine but seemingly more commonplace with the increasing use of MRI imaging in neurovascular clinics. There are a number of pathophysiological mechanisms linking migraine and stroke; cortical spreading depression is a key mechanism. Typically in an attack one or more migrainous aura symptoms are prolonged over 60 minutes, corresponding with cerebral ischaemia. The association between migraine and stroke is stronger for women, women under the age of 45 years old, women who smoke, and those who use oral contraceptives. Herein, we discuss a case of a 40 year old woman migraineur presenting with headache and homonymous right superior field defect. Corresponding MRI brain imaging showed restricted diffusion consistent with acute infarction in the medial aspect of the left occipital lobe.