An uncommon cause of intracerebral hemorrhage in a healthy truck driver

Objectives: To describe a case and review literature for intracerebral hemorrhage caused by migraine. Design: Case report. Setting: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Patient: A 54-year-old truck driver with a 2-year history of atypical headaches. Results: A54-year-old right-handed truck driver was seen in consultation with a 2-year history of atypical headaches. The headaches were dull, throbbing, gradually progressive, and limited over the left occipital area. They were accompanied by right visual field deficit, diplopia, and, at times, confusion. These headaches were notably different from the usual migraine headaches he had been having for more than 20 years. Brain imaging revealed left parieto-occipital lobar hemorrhage. Further investigations ruled out arteriovenous malformations. He did not have any vascular risk factors, including hypertension. Migraine-associated intracerebral hemorrhage was considered to be the most likely diagnosis. Conclusions: Intracerebral hemorrhage associated with migraine is believed to result from vasoconstriction leading to ischemia of the walls of blood vessels, making them leaky and porous. It is important to be aware of this phenomenon because vasoactive medications used to treat migraine can further aggravate the vasoconstriction and hence the intracerebral bleed.