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Images in Neurology
August 2000

Resolution of Migraine With Aura Caused by an Occipital Arteriovenous Malformation

Arch Neurol. 2000;57(8):1219. doi:10.1001/archneur.57.8.1219

A 34-year-old man started to experience periodic headaches in 1992. The attacks usually were heralded by a visual prodrome consisting of scintillating bright lights in the left visual field that slowly expanded over several minutes. Shortly after the visual symptom subsided, right-sided throbbing headaches developed along with nausea and vomiting, which usually lasted 2 to 4 hours. The headaches occurred about monthly. There were no noticeable triggering factors for the episodes. He had no prior episodes or family history of migraine or epileptic seizures. Results of neurological and ophthalmological examinations were unremarkable. Magnetic resonance imaging (MRI) and cerebral angiography disclosed an unruptured right occipital arteriovenous malformation (AVM) with a maximum diameter of 2 cm (Figure 1, A and B) that was treated by radiosurgery in November 1994. A single dose of 25 Gy was delivered to the margin of the lesion. The headaches gradually decreased in frequency and disappeared by 18 months after the treatment. Neuroimages performed 2.5 years after the irradiation showed complete obliteration of the AVM (Figure 1, C and D). No complications resulted from the treatment. At the time of this report, he had been free from headache for more than 3 years and remained neurologically intact. No prophylactic medication was used during the treatment course.

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