1.2.2 Migraine with brainstem aura

Identification: Female patient, 32 years old, teacher, with no previous comorbidities.

Clinical History: The patient reports recurrent episodes of headache for 5 years, initially sporadic, but with increased frequency in the last 6 months (2 to 3 episodes per month). She describes the headache as pulsatile, unilateral (alternating sides), of moderate to severe intensity, lasting 4 to 12 hours, associated with photophobia, phonophobia, and nausea. In the past year, she began experiencing transient neurological symptoms prior to the headache, characterized by intense vertigo, diplopia, dysarthria, and ataxia, lasting 20 to 30 minutes, followed by the headache. She denies loss of consciousness or persistent motor deficits.

Physical and Neurological Examination: During the consultation, the patient was asymptomatic. The neurological examination was normal, with no focal signs, alterations in strength, sensitivity, or coordination. Fundoscopy was unremarkable.

Complementary Investigation:

Brain MRI: normal.

Intracranial artery MR angiography: unremarkable.

EEG: no epileptiform activity.

Laboratory tests (complete blood count, metabolic profile, TSH): within normal limits.