Gastroenteric-induced Bilateral Paroxysmal Hemicrania

BACKGROUND: Functional gastrointestinal disorders; i.e., irritable bowel syndrome, cyclic vomiting, gastro-esophageal reflux and dyspepsia, are more common in individuals with migraine. Autonomic manifestations of migraine, and less commonly of paroxysmal hemicranias (PH), include those of gastrointestinal (GI) tract origin. METHODS: Repeated cl inical neurological examinations, long term follow up and ancillary medical tests including imaging procedures. CASE REPORT: An 81 year old female patient had recurrent episodes of bilateral paroxysmal hemicrania with limited cranial autonomic symptoms, consistently triggered a few minutes after beginning to eat, in the absence of concurrent GI or other autonomic symptoms. There was no specific food trigger and drinking fluids (i.e., cold water) did not cause headache. Repeated clinical examinations and ancillary testing were normal. The patient symptoms were terminated by a course of corticosteroids. CONCLUSION: Exceptionally, bilateral paroxysmal hemicrania is precipitated by eating, in the absence of underlying structural brain lesions