Deterioration of migraine headache after treatment with triptans agent in patient with occipital AVM

Abstract

We report a case of a 16-year-old boy with chronic headache, who was diagnosed as arteriovenous malformation (AVM) on occipital lobe (Spetzler-Martin grade 5). He continued to suffer from the attack of migraine-like headache with visual aura of homonymous hemianopia even after proton therapy. Due to initiating preventive drug for migraine, the headache attack was relieved rapidly. However, relapse of the attack was noted in the subsequent year, and then specific treatment with triptans was started in the acute stage. Because migraine-like headache lasted progressively despite the use of triptans, matching definite increase in occipital blood flow, such situations seemed to be some possibilities of adverse effects by triptans affecting blood flow. By finishing the triptans, chronic headache disappeared quickly. An etiologic relationship was suggested between the headache attack and the increase of regional cerebral blood flow, since the obvious decrease in blood flow was apparent during non-headache phases. It seemed probable that regional blood flow in normal brain may shift to the region in nidus because of little difficulty in induction of vascular contractile effect in AVM with an abnormal structure of blood vessels as to the using triptans against migraine-like headache. It may be suggested to lead to worsening headache symptoms based on hyperperfusion with further increase of nidual blood flow in cases of migraine attacks with AVM.