Abstract
Episodic spontaneous hypothermia is an infrequent disorder. Here, the case of a patient with migraine who experienced hypothermia during her migraine attacks is presented. The authors propose that larger clinical series should be studied to evaluate the occurrence of hypothermia in migraine, as well as the possible influence of some preventive regimens in this setting.
Introduction
Hypothermia less than 35°C may be observed under several circumstances, providing that the thermoregulation centres are affected (1). Most cases are related to cranial trauma, brain malformations, infarcts or tumours (2). Episodic spontaneous hypothermia is an infrequent disorder. Here, we present the case of a patient with migraine who experienced hypothermia during her migraine attacks.
Case report
A 52-year-old woman without any relevant medical history was referred to our headache unit because of recurrent headache and hypothermia. She had suffered episodic headaches since she was on her twenties. Her clinical picture fulfilled International Headache Society diagnostic criteria (ICHD-II) for migraine without aura (3). The headache was unilateral (with side-shift), pulsating, and severe. Headache attacks were regularly accompanied by nausea, photo-, phono- and osmophobia. In addition, the attacks were consistently associated with a sense of hypothermia, and she had measured and axillary temperature lower than 35°C on several occasions. Headache frequency was about two attacks/month. We asked the patient to write down her axillary temperature for a period of 3 months, every day in the morning and whenever she had a migraine attack, making use of a calibrated clinical thermometer. A total number of six attacks were registered. Throughout this period, the interictal temperature was always normal (36.2–36.7°C), while the recordings taken during the migraine episodes repeatedly fell to between 34.2–35.4°C. Otherwise, physical and neurological examinations, and all laboratory tests including cranial magnetic resonance imaging were normal.
Discussion
Hypothermia has been seldom recognised as a symptom of migraine. Some authors think that episodic spontaneous hypothermia occurring in children might be considered a periodic childhood syndrome linked to migraine (2). The presence of hypothermia during migraine attacks in our patient could be related to a hypothalamic dysfunction. Indeed, several lines of evidence support and involvement of the hypothalamus in migraine, and PET scanning has confirmed hypothalamic activation prior to migraine headache (4).
We do not really know the actual incidence of hypothermia during migraine episodes because we do not check the patients’ temperature on a routine basis. Hypothermia may be not exceptional in migraine. Recognition of this phenomenon can be important from a therapeutic point of view because some preventive drugs such as valproic acid, especially when combined with topiramate, may induce or facilitate hypothermia (5,6). We think that larger clinical series should be studied in the future in order to evaluate the occurrence of hypothermia in migraine, as well as the possible influence of some preventive regimens in this setting.