A woman in her 40s with an unusual migraine attack.

BACKGROUND: Migrainous infarction is a rare complication of migraine with aura, accounting for 0.5-1.5 % of all ischaemic strokes. Migraine with aura increases the risk of ischaemic stroke, particularly in women using oral contraceptives. Migrainous infarction is defined as an ischaemic stroke that occurs during a typical migraine with aura attack and is associated with a neuroimaging-confirmed ischaemic brain lesion in the relevant area. CASE PRESENTATION: This case describes a woman in her forties with a history of migraine with visual aura who developed transient neurological symptoms - including vertigo, visual disturbances in the left eye and left-sided numbness and weakness - followed by a severe fronto-occipital headache. MRI revealed two small acute infarcts in the right occipital and posterior parietal lobes, consistent with migrainous infarction. No embolic source or other cause was identified in extensive cardiovascular, haematological and autoimmune investigations. The patient was treated with dual antiplatelet therapy and a statin for secondary prevention and made a full recovery with no recurrent migraine attacks. INTERPRETATION: This case highlights the importance of thorough anamnesis in patients with migraine. New or atypical aura symptoms, prolonged focal deficits, or changes in headache pattern should prompt urgent neurological evaluation and imaging to rule out ischaemic stroke. Early recognition is critical to ensure appropriate management and prevent long-term sequelae.