Abstract
A 20-year-old female with hemiplegic migraine was treated during an acute attack with intravenous verapamil, which reproducibly resolved the headache within 20 min but did not affect her hemiplegia. Magnetic resonance (MR) and computed tomographic (CT) angiography and perfusion performed during the attack showed vasodilation and hyperperfusion. Cerebral hyperperfusion concurrent with hemiplegia suggests a dissociation between cerebral perfusion and neuronal function in hemiplegic migraine. The beneficial effect of verapamil on headache but not hemiplegia suggests a distinct mechanism for pain and neuronal dysfunction in hemiplegic migraine, with the beneficial effect on pain not due to vasodilation.
MeSH terms
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Adult
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Brain / blood supply
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Brain / drug effects
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Brain / physiopathology
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Cerebral Angiography
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Cerebral Arteries / diagnostic imaging
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Cerebral Arteries / drug effects
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Cerebral Arteries / physiopathology
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Cerebrovascular Circulation / drug effects*
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Cerebrovascular Circulation / physiology
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Cerebrovascular Disorders / diagnostic imaging
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Cerebrovascular Disorders / physiopathology*
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Female
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Gadolinium
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Hemiplegia / diagnostic imaging
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Hemiplegia / etiology
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Hemiplegia / physiopathology
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Humans
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Hyperemia / diagnostic imaging
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Hyperemia / physiopathology*
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Injections, Intravenous
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Magnetic Resonance Imaging
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Migraine with Aura / diagnostic imaging
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Migraine with Aura / drug therapy*
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Migraine with Aura / physiopathology*
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Pain / drug therapy
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Pain / etiology
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Pain / physiopathology
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Tomography, X-Ray Computed
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Treatment Outcome
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Vasodilation / drug effects
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Vasodilation / physiology
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Vasodilator Agents / administration & dosage
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Verapamil / administration & dosage*
Substances
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Vasodilator Agents
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Gadolinium
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Verapamil