Chronic migraine with aura as a neurologic manifestation of an atrial myxoma - A case report

Introduction and importance: Atrial myxomas account for more than half of all cardiac tumors. While the symptoms of these are many, the most prominent among them being migraines, heart failure, dyspnea, and chest pain thereby making a diagnosis all the more difficult. Case presentation: A 53-year-old woman presented with a recent onset of headaches with aura. The latter was triggered by exercise and physical exertion. Taking Ibuprofen 800 mg three times daily provided relief to the patient. Headaches were associated with photophobia and nausea. Clinical discussion: The patient had the typical triad of symptoms, namely (i) obstructive (light headedness, near syncope, dyspnea, chest pain), (ii) embolic (transient ischemic attacks – TIA, peripheral arterial claudication), and (iii) constitutional (fever, malaise, weight loss). Cerebral infarction is the most frequent complication. The patient had multiple embolic acute and sub-acute infarcts. The aura and headaches were resolved following resection of the myxoma. Conclusion: Atrial myxomas must enter the differential diagnosis in the case of a patient presenting with migraines associated with aura. In particular, those whose headaches increase with physical exertion require further investigation.