Recurrent Epistaxis: An Unusual Manifestation of Clinical Spectrum of Migraine -Case Series with Scoping Review of Literature

Objective: We report four cases of migraine induced epistaxis and reviewed the published literature of migraine with epistaxis to establish demographic profiles, types of migraine, severity, family history of headache and other associated disorders in adults. Methods: A panoramic search of the Medline database through Pubmed was done in May 2022 using search terms: {Migraine with Epistaxis}, case reports. All articles/case reports in English from January 2001 to April 2022 where age of patients was > 18 years were included in our review. Results: Our search recognized total of three cases and with inclusion of the four cases who reported to us, we reviewed these seven cases and studied demographic profile, clinical features, association of epistaxis with types and severity of migraine and relationship with other medical disorders. Mean age of presentation was 28.7 years (range 18–49), with five female and two male patients. The intensity of headache was severe in three of seven cases and there was one case each of moderate and mild category. Five of seven (71%) patients had reduction in intensity of headache with onset of bleeding and various types of migraine (Migraine with and without Aura, vestibular migraine, sporadic familial hemiplegic migraine) according to ICHD classification were associated with epistaxis. Four of seven had positive family history of migraine. There was no diagnostic finding in any patient and all patients responded to migraine preventive medication. Conclusion: Recurrent epistaxis is not so uncommon manifestation of various types of migraine and specialist should keep this clinical diagnosis in mind to avoid misdiagnosis.