Persistent Migraines Turn Out to be Something Much Worse

by Denis Storey
March 13, 2024 at 10:27 AM UTC

Clinical relevance: A 52-year-old man with a history of migraines sought help when his usual treatments failed. But his real diagnosis surprised everyone.

  • Despite no typical risk factors, doctors found he had neurocysticercosis, a tapeworm infection in the brain.
  • Neurocysticercosis, caused by ingesting tapeworm cysts, is rare in developed countries but can lead to seizures and varied symptoms.
  • This case highlights the importance of considering uncommon causes for migraines and the need for vigilance in diagnosis, even in regions where such infections are rare.

Migraines are the worst. Roughly 10 percent of the world’s population lives with the fear that another debilitating headache might blindside them.

Imagine something worse than that. A 52-year-old Florida man didn’t have to.

The man – who had a history of migraines – noticed that they’d started popping up at least once a week over the previous four months. So he went to the hospital since his typical treatment regime offered no relief. The man, a type 2 diabetic with a history of obesity, hadn’t traveled abroad to any high-risk areas or farms.

Solving the Migraine Mystery

The man’s story, as reported in the American Journal of Case Reports, explained that the patient didn’t suffer from food insecurity. He lived in a typical modern house with his wife and their cat.

The emergency room doctors pressed him, however, after he insisted that he never ate any raw or street vendor food. That’s when he admitted that he loved “lightly cooked, non-crispy bacon for most of his life.”

The normal lab tests offered no insight. A CT scan appeared to reveal  “congenital neuroglial cysts,” but a neurological consult – and an MRI – solved the mystery conclusively. The doctors discovered the patient had neurocysticercosis – or tapeworm eggs – in his brain.

Breaking Down the Science

Cysticercosis, according to the U.S. Centers for Disease Control and Prevention (CDC), is a “parasitic tissue infection caused by larval cysts of the tapeworm Taenia solium. These larval cysts infect the brain, muscle, or other tissue, and are a major cause of adult-onset seizures in most low-income countries.”

Taenia solium is a pork tapeworm that usually only infects humans when they’ve consumed the cysts left behind in butchered pork or its feces. It’s a transmission rarely witnessed in the First World.

Neurocysticercosis, however, occurs when the tapeworm’s larval cysts lodge themselves into a patient’s nervous system. That can mean “anywhere from brain parenchyma to the ventricular system and spinal cord and have wide variability in symptoms at presentation, depending on which structures and tissues they have infected,” according to the report.

Most neurocysticercosis patients present with seizures at first, which prompts medical professionals to turn to neuroimaging, as they did in this case.

What All This Means

The authors of this study insist that this man’s case can teach us a few things:

  1. It’s exceedingly rare for patients to contract neurocysticercosis in this context. And most medical professionals would have discounted cases list this cropping up in the United States. “Undercooked pork consumption is a theoretical risk factor for neurocysticercosis via autoinoculation, as we suspected in this case. It is historically very unusual to encounter infected pork in the United States, and our case may have public health implications.”
  2. Neurocysticercosis is malleable, which can present problems for diagnosis. “The great variability of symptoms that neurocysticercosis can present with should not be understated, and although it is a leading cause of epilepsy worldwide, it can present with more subtlety.”
  3. “It is important to keep neurocysticercosis and other etiologies of central nervous pathology on the differential diagnosis when evaluating acute changes in migraines, even when there are no classic risk factors.”

And the patient? After a course of antiparasitic and anti-inflammatory drugs, the lesions whithered away – as did his migraines.

Further Reading

Paroxetine Prevents Migraines

New Migraine Drug May Even Prevent Treatment-Resistant Cases

MRI Study Reveals Never Before Seen Brain Changes in Migraine

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