Familial hemiplegic migraine (FHM) is a rare, autosomal dominant
subtype of migraine characterized by transient hemiparesis and
neurological symptoms. It is primarily associated with mutations in
the CACNA1A, ATP1A2, and SCN1A genes, which disrupt neuronal
excitability and contribute to complex clinical presentations. Although
psychotic symptoms accompanying migraine attacks in FHM are
exceedingly rare, they have been documented in a limited number of
cases. This article presents a case of FHM diagnosed in a patient who
exhibited transient psychotic symptoms during a migraine attack, with
a focus on diagnostic and therapeutic approaches. The case is discussed
in comparison to other rare instances reported in the literature.
Psychotic symptoms in FHM are thought to arise from mechanisms
such as cortical spreading depression and cerebral hypoperfusion. These
symptoms are typically short-lived and respond rapidly to antipsychotic
treatment. However, careful evaluation is essential to differentiate
these episodes from primary psychotic disorders, thereby avoiding
unnecessary prolonged antipsychotic use. This case underscores
the importance of a thorough clinical assessment in FHM patients
presenting with atypical psychiatric manifestations. The article aims
to contribute to the understanding and management of psychotic
symptoms in FHM, emphasizing the need for a multidisciplinary
approach to diagnosis and treatment. Further research is warranted to
elucidate the pathophysiology of psychosis in FHM and to optimize
therapeutic strategies for this rare but clinically significant presentation.
Keyword: Case report, cortical spreading depression, familial hemiplegic
migraine, psychotic disorders