title: Status migrainosus as an initial presentation of multiple sclerosis.
abstract: BACKGROUND
  Demyelinating plaques may induce headache through disruption of the pathways, which are implicated in the pathogeneses of migraine. We report a case of 25-year-old female patient, who presented with status migrainosus fulfilling the criteria of international classification of headache disorder. She was eventually diagnosed with multiple sclerosis (MS) after an extensive work-up and long-term clinical and radiological follow-up.
  
  
  RESULTS
  At the onset of status migrainosus, magnetic resonance imaging (MRI) revealed the presence of several demyelinating lesions fulfilling Swanton criteria. She was started on migraine prophylactic treatment but there was no subsequent response. One year later, she presented with recurrent status migrainosus and a follow-up MRI revealed multiple gadolinium-enhancing lesions in the brain. She was treated with abortive migraine medications. Within the following 2 year, she developed ascending parasthesia and weakness of both lower limbs indicative of incomplete transverse myelitis in association with recurrent status migrainosus. A diagnosis of MS was established based on a follow-up MRI that satisfied the revised 2010 McDonald criteria. Both the headache and neurological signs improved with IV methylprednisolone therapy. Her headache entered remission after initiation of a disease modifying therapy.
  
  
  CONCLUSIONS
  Status migrainosus can be the initial presentation of MS. Unresponsiveness to migraine prophylactic therapy in the presence of active demyelinating plaque in MRI brain may pose a diagnostic challenge and a diagnosis of MS might be considered.
authors: Division of Neurology, Department of Medicine, Amiri Hospital, Arabian Gulf Street, Sharq, 13041 Kuwait ; Neurology Clinic, Department of Medicine, Dasman Diabetes Institute, P.O. Box 1180, Dasman, 15462 Kuwait.
authors: Raed
authors: R
authors: Alroughani
authors: Department of Neurology, Ibn Sina Hospital, P.O. Box 25427, Safat, 13115 Kuwait ; Department of Neurology & Psychiatry, Al-Minia University Hospital, P.O. Box 61519, Minia, 61111 Egypt.
authors: Samar F
authors: SF
authors: Ahmed
authors: Department of Neurology, Ibn Sina Hospital, P.O. Box 25427, Safat, 13115 Kuwait.
authors: Riyadh
authors: R
authors: Khan
authors: Department of Neurology, Ibn Sina Hospital, P.O. Box 25427, Safat, 13115 Kuwait ; Department of Medicine, Kuwait University, P.O. Box 24923, Safat, 13110 Kuwait.
authors: Jasem
authors: J
authors: Al-Hashel
keywords: MRI; Migraine; Multiple Sclerosis
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