[Coma associated with migraine].
BACKGROUND
Basilar migraine is a particular form of migraine with an aura in which crises of headache are accompanied by symptoms of dysfunction in the vertebro-basilar territory, including alteration of consciousness in the form of stupor or coma.


METHODS
We report four patients, three men of 14, 17 and 83 years of age and one woman of 21. All had previous histories of migraine and presented with transitory episodes of coma. During the coma, the woman woke up spontaneously with intense bulimia. In the three men, it was seen, on injecting flumazenil, that the state of consciousness and the EEG returned to normal transiently. Neuroimaging studies (CT and MR) were normal in all patients.


CONCLUSIONS
Migraine-coma is an exceptional, emergency condition in which structural, infectious, toxic and metabolic pathology of the Central Nervous System should be ruled out. As well as in patients with basilar migraine, the association of migraine and coma may also be seen in patients with familial hemiplegic migraine and CADASIL and MELAS syndromes. It may be that gabaergic mechanisms are involved in the theoretical dysfunction of the ascending reticular activating system causing alteration of consciousness, since in the three patients in whom flumazenil was injected, there was a response.
Requena
I
I
Departamento de Medicina, Complejo Hospitalario Universitario de Santiago de Compostela, España.
Indakoetxea
B
B
Lema
C
C
Santos
B
B
García-Castiñeira
A
A
Arias
M
M
D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D003128:Coma / Q000209:etiology*; D004632:Emergency Medical Services; D005260:Female; D005442:Flumazenil / Q000627:therapeutic use; D018757:GABA Modulators / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008881:Migraine Disorders / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D012154:Reticular Formation / Q000503:physiopathology; D014057:Tomography, X-Ray Computed
D018757:GABA Modulators; D005442:Flumazenil