Hemiplegic migraine: hyperperfusion and abortive therapy with intravenous verapamil.
A 20-year-old female with hemiplegic migraine was treated during an acute attack with intravenous verapamil, which reproducibly resolved the headache within 20 min but did not affect her hemiplegia. Magnetic resonance (MR) and computed tomographic (CT) angiography and perfusion performed during the attack showed vasodilation and hyperperfusion. Cerebral hyperperfusion concurrent with hemiplegia suggests a dissociation between cerebral perfusion and neuronal function in hemiplegic migraine. The beneficial effect of verapamil on headache but not hemiplegia suggests a distinct mechanism for pain and neuronal dysfunction in hemiplegic migraine, with the beneficial effect on pain not due to vasodilation.
Hsu
David A
DA
Department of Neurology H6/526, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA. hsu@neurology.wisc.edu
Stafstrom
Carl E
CE
Rowley
Howard A
HA
Kiff
Jane E
JE
Dulli
Douglas A
DA
D000328:Adult; D001921:Brain / Q000098:blood supply / Q000187:drug effects / Q000503:physiopathology; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000187:drug effects* / Q000502:physiology; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005682:Gadolinium; D006429:Hemiplegia / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D020325:Migraine with Aura / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology*; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014664:Vasodilation / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage; D014700:Verapamil / Q000008:administration & dosage*
D014665:Vasodilator Agents; D005682:Gadolinium; D014700:Verapamil