Unraveling the Threads: A Case Report on Confusional Migraine and the Intricate Dance Between Psychiatry and Neurology.

Background: Migraine affects about 1 billion people worldwide and is associated with a significant negative impact on personal and occupational functioning. Migraine accompanied by aura is seen in about 15% of migraineurs. Visual aura is the most common type of aura. Much less common though are auras that involve higher mental function, such as confusional state. The confusional state may manifest with a wide variety of cortical dysfunction, such as speech impairment, increased alertness, agitation, and amnesia, often lasting longer than a typical migraine aura.

Case presentation: The authors present the unique case of a 29-year-old patient with episodic and transient bizarre behavioral symptoms in the context of migraine headaches.

Conclusion: Our patient's presentation is suggestive of acute confusional migraine, which poses several diagnostic complexities and illustrates the difficulties with symptomatology that might have a medical/organic component versus a psychiatric one. The literature on this topic is lacking, and further research into this condition is warranted to optimize comprehensive patient care.