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A woman who is 24 weeks pregnant presents to her PCP with symptoms of worsening headaches as the pregnancy progresses. She is 25 years of age with a history of headaches since age 15.

The pregnancy is normal and uneventful, the woman is otherwise healthy and she takes no medications, but did take sumatripan prior to getting pregnant. She does not use tobacco or illicit drugs and does not drink alcohol because it brings on the headache. Several hours prior to each headache, the patient experiences fatigue with mild nausea and a disturbed visual field. Headaches last up to 8 hours and are helped by sleep.

At the beginning of the pregnancy, headaches occurred monthly but are increasing in frequency. Her family history shows that both her mother and brother experience the same headaches. The medical exam is normal, and a pre-pregnancy MRI shows small subcortical white matter T2 hyperintensities.

The patient is diagnosed with classic migraine with aura because her headaches start with the sensory disturbances and because the headache follows the initial neurologic symptoms within one hour.

Patients with migraine often describe a onset symptoms of fatigue, nausea, irritability, excessive thirst, or depression hours or even days before the start of the headache.

Question: Do you agree with this diagnosis?

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