A 52-year-old female was admitted following 1-week history of headache, and 1-day history of vertigo.

Her only past medical history was migraine. She is a non-smoker. She is not on any medications including contraceptive pills.

The headache was like her usual throbbing headache- on the right side of head, associated with nausea, and photophobia. Visual flickering had already resolved on admission. This was not relieved by over-the-counter painkiller.

She experienced vertigo on the day of admission which was new for her.

Clinical examination revealed normal neurological examination apart from ataxia. Other cerebellar signs were notably absent.

She was initially treated for migraine with aspirin, prochlorperazine and sumatriptan with no success.

MRI head revealed small acute infarct in right cerebellum. MRA showed no aneurysm or dissection. All young stroke diagnostic work-up were unremarkable.

Discussion Migraine may mimic stroke. It is also known to increase the risk of stroke, particularly in women who have migraine with aura. There is an association between migraine with aura and silent infarct-like lesions on brain MRI located mainly in the posterior circulation white matter or cerebellum. Thus in this case, migraine is likely to be a cause of stroke, although coincidental occurrence cannot be ruled out.