Basilar Migraine

Dizzy 2

Step 1: View clinicals

A 16 year old boy presents with a severe, throbbing headache which started suddenly and has lasted for around an hour. The headache started at the back of his head and then extended frontally. He also experienced nausea, dizziness and blurring of vision. He had experienced a similar headache twice in the past 2 months. His medical history is unremarkable and he has no allergies. His father has had episodic headaches in the past.


Step 2: Order all relevant investigations

MRI + MRA Brain

The MRI + MRA is normal, with no evidence of space occupying lesions, hemorrhages or aneurysms.

Lumbar puncture

Xanthochromia: absent WBC: 3/mm3 (0 - 5) Protein: 47 mg/dL (15 - 60) Glucose: 73 mg/dL (50 - 80)

EEG

No epileptiform activity is noted.

Toxicology Screen

The toxicology screen is completely unremarkable.


Step 3: Select appropriate management

Sumatriptan
Indomethacin
Antiemetics
Verapamil


Score: ★★☆