Meningeal lesions mimicking migraine

Abstract

Arteriovenous malformations are commonly acknowledged as mimicks of migrainous syndromes. The authors describe classical migraine of many years' duration that preceded the diagnosis of a meningioma in three patients. Two patients had an occipital meningioma, and a fronto-temporal meningioma was found in the third. Visual symptoms in two patients were exceptional by their constant localization in the same hemianopic field, while in the third patient they involved either hemianopic field. Sometimes the visual phenomena occurred independently of the headache. In one patient a causal relationship with the migrainous condition was further supported by its cessation following removal of the tumor. These observations permit the differential diagnosis of both classical migraine and dissociated visual phenomena to occasionally include a meningioma.

Activation of intradural and extradural arteriovenous shunts has been suggested to play a role in the pathogenesis of migraine. Support for this hypothesis is inferred from the migrainous symptoms of the authors' patients and the lesions which derive a rich blood supply from the dura.

Key Words:

• migraine
• visual phenomenon
• meningioma
• arteriovenous shunts