Vertebral Artery Dissection Mimicking Migraine: A Case Report

Rahalkar Kshitij*, Hong K. Lau and R Ponampalam

Vertebral Artery Dissection Mimicking Migraine: A Case Report

Vertebral artery dissection is an important cause of stroke in patients under 50-years of age
and presents with headache with or without neck pain. It occurs with focal neurological signs
but sometimes it may occur without any neurological deficits and may mimic migraine.

A 28-year-old female with past history of chronic migraines presented to the emergency
department with headache, neck stiffness and vertiginous giddiness.
There was no prior trauma and there were no gross neurological deficits.
Patient was discharged with analgesics.

The patient returned with persistent headache and giddiness 3-days later. Gait was steady
however patient was unsteady on tandem gait. There were no other neurological signs.
magnetic resonance imaging brain with magnetic resonance angiography showed dissection
of right vertebral artery with acute infarct in the right cerebellar hemisphere.

Patient was stable and was discharged on dual antiplatelet therapy. Although many VAD
cases are caused by minor trauma to head and neck and usually have focal neurological deficits,
it would be advisable to keep VAD as a differential diagnosis when dealing with patients with headache without history of trauma and no neurological deficits as it may mimic migraine and would alter
the course of treatment and influence morbidity and mortality of the patients.

Emerg Med Open J. 2021; 7(1): 21-24. doi: 10.17140/EMOJ-7-162