1.2.2 Migraine with brainstem aura

A 32-year-old female patient, a teacher, with no previous comorbidities. Clinical History: The patient reports recurrent headache episodes for 5 years, occurring 2 to 3 times a month. She describes the pain as pulsatile, unilateral (alternating sides), with moderate to severe intensity, associated with photophobia, phonophobia, and nausea. The duration varies from 4 to 12 hours, with improvement after resting in a dark environment and using common analgesics (paracetamol or ibuprofen), although not always effective. In the last 6 months, the patient began experiencing premonitory neurological symptoms, which precede the headache by 20 to 30 minutes. She reports blurred vision, diplopia (double vision), dysarthria (difficulty articulating words), mild ataxia (imbalance while walking), and bilateral paresthesias in the hands and lips. These symptoms last from 20 to 40 minutes and completely resolve before the onset of the headache. Physical and Neurological Examination: General physical examination: unremarkable. Neurological examination: during the aura, mild dysarthria and ataxia were observed, with normal reflexes and preserved muscle strength. After the resolution of the aura, the neurological examination was completely normal. Complementary Examinations: Brain MRI: no structural abnormalities. MR angiography of intracranial vessels: no evidence of malformations or aneurysms. Electroencephalogram (EEG): normal. Laboratory tests (complete blood count, metabolic profile, TSH): within normal limits.