Abstract
We present a rare case of headaches associated with dysphonia in a 70 year old female (BM) that proved resistant to various migraine medications until the introduction of fremanezumab; a calcitonin gene-related peptide (CGRP) monoclonal antibody.
BM’s atypical headaches began suddenly 20 years ago as a throbbing occipital headache radiating to the neck.
Her headaches have been associated with left facial numbness, blurred vision, subjective hearing impairment, and an unusual feature of dysphonia. Over the past year, her acute headache attacks increased in frequency from monthly to > 15 days per month. Dysphonia occurred during her episodes of migraines, sometimes for up to a few days, and was not associated with carotidynia.
MRI/MRA brain showed nonspecific white matter T2 hyperintensities, showed no features of vasculitis. There was no structural cause for her dysphonia.
SPECT-CT showed mild degenerative changes and facet joint arthritis on the right (however BM had left sided symptoms).
Bloods: borderline ANA, negative ANCA/anti-dsDNA, negative AChR-antibodies/anti-Musk antibodies.
The headaches failed to have a satisfactory response to pizotifen, propranolol, sodium valproate, verapamil, baclofen, amitriptyline, topiramate, duloxetine, opioids and occipital nerve block. She could not tolerate high dose pregabalin. BM has been commenced on fremanezumab to good effect. She continues to have occasional episodes of dysphonia though no longer suffers from any headaches.
Migraines associated with dysphonia are an underrecognised clinical presentation that has been reported in medical literature.1 Our case demonstrates that there continue to be rarer associations found with the common neurological condition of migraine.
Reference
Ordás CM, Torres-Gaona G, Pardo-Moreno J, Cuadrado ML. Case report: prolonged dysphonia during migraine attacks. Headache. 2017 Mar;57(3):497–499. doi: 10.1111/head.13026. Epub 2017 Jan 30. PMID: 28133738.
