A case of idiopathic subdural hematoma developed from migraine

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Headache is a common symptom, and migraine in young women is a common condition correlating with periodical gonadal activity. A 34-year-old woman visited our ambulatory care with severe nuchal and right frontotemporal pain and nausea. Prior to her visit to our clinic, this patient was diagnosed with migraine and prescribed 2.5mg naratriptan hydrochloride tablets. Although her headache had worsened, no overt neurological functional deficits of the pyramidal tract, extrapyramidal tract, or cranial nerves were observed. A right temporal subdural hematoma (SDH) that spread to the frontal subdural space and surrounded the right cerebellar hemisphere was found on computed tomography and magnetic resonance imaging. In addition, a magnetic resonance angiography revealed an aneurysm at the C3 portion of the left internal carotid artery. The patient was prescribed oral drugs for hemostasis and her clinical course was followed; the lesions disappeared after 7 weeks. SDH is rare in young women, and unfavorable associations between triptans and serious vascular events, including ischemic cerebrovascular strokes, aneurysms, and artery dissections, have been reported in the Food and Drug Administration Adverse Event Reporting System database. Given the severity of potential complications, this case study suggests that triptans should be used with strict caution in migraineurs.

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