Migraine and epistaxis: An interesting combination

This is the report of a 28 year old woman who had a holocranial pulsating headache once a month with nausea, photophobia and phonophobia lasting about 48 hours. There was no preceding aura. The headache used to subside on every occasion with profuse epistaxis from both nostrils. Her neurological and otolaryngological examination was normal. MRI brain showed no abnormality. During one of the examinations at the time of the headache and epistaxis, she was found to have bilateral congestion of nasal mucosa with no obvious identifi cation of bleeding points. This case illustrates that migraine can result in epistaxis in some patients.

Multiple myeloma presenting as cerebral venous sinus thrombosis

A 52-year old lady presented with acute onset headache, seizures, confusion and was found to have anemia, albumin/globulin ratio reversal and cerebral venous sinus thrombosis. On further investigations, multiple myeloma was found to be the underlying cause. The patient recovered fully with anticoagulation and chemotherapy. This case indicates that cerebral venous sinus thrombosis can be an unusual presenting manifestation of myeloma.