Abstract
Background
Hemiplegic migraine is a rare form of migraine with aura that causes fully reversible motor weakness along with other reversible sensory, visual and/or speech/language symptoms. There are two forms of hemiplegic migraine: a familial type and a sporadic type. There are few case reports that mention the presentation of psychosis in the familiar type. In this case report, we present a sporadic form that present with psychotic symptoms. Also, will present the effect of lamotrigine as a treatment option.
Case presentation
This is a case report of an 18-year-old girl who is known to have migraine and schizophrenia ,and weretreated with olanzapine for psychosis. She presented to the ED following a severe migraine attack and unilateral motor weakness that progressed later to labile mood, hyperphagia, lapses in memory, confusion and eventually to catatonic stupor. During the inpatient admission, further assessment took place, and her diagnosis of schizophrenia was changed to sporadic hemiplegic migraine. She later reported that she develops auditory and visual hallucinations only after severe migraine attacks. The hallucinations vanish within 24-48 hours after the headache resolves.
Conclusion
Complex auditory and visual hallucinations could be associated with sporadic hemiplegic migraine. There are no case reports that documented the association of sporadic form and psychosis, and further studies should be conducted.
Antipsychotic (Olanzapine) was successful in treating and preventing psychosis associated with hemiplegic migraine, but it had no effect in reducing migraine severity and frequency. Lamotrigine showed more than 50% subjective improvement in patient migraine’s frequency and intensity and decreased the episodes of psychosis associated with it.