34 yo female homemaker presented to her family physician with a complaint of sudden onset, severe, throbbing, unilateral headache, right sided, associated with a single episode of non bilious non projectile vomiting. No blurring of vision, vertigo. Her blood pressure was measured to be 150/105 mm Hg. she was given some medication her headache got relieved. Pt always gets unilateral headaches whenever she does get a headache.
The next afternoon she began experiencing abnormal jaw movements, deviating to both right and left sides, contorting movements of the lips. it was followed by jerky (not tonic and clonic) movements of the left lower limb, and the left upper limb followed soon after. These episodes would last for 5-7 minutes, with a 2-3 minute break, and then would start again. Mild lower left limb weakness post first episode, but otherwise able to walk.
No h/o loss of consciousness, bladder and bowel control, abnormal taste, smell, vision, head trauma, fever, neck rigidity. No h/o prior hysterical episodes.
What could this be? Could the migraine be related?