Unexpected Discovery of a Left Tentorial Meningioma During Evaluation for Chronic Migraine: Significance of Red-Flag Symptoms

Although chronic migraine is a very common neurological condition, physicians should look for secondary causes of headaches when unusual or red-flag symptoms appear[1]. We describe the case of a 33-year-old female patient who had a history of migraine-like headaches. Her headache pattern abruptly changed, becoming more severe, worsening in her posture, and not responding well to analgesics. Neuroimaging was performed as a result of these alarming characteristics, and the results surprisingly showed a left tentorial meningioma. A distinct extra-axial, dural-based enhancing mass adjacent to the left cerebellar hemisphere was seen on MRI. It was accompanied by a modest mass effect and considerable perilesional edema. A WHO Grade I meningothelial meningioma was confirmed by histological analysis after the patient had a left retromastoid craniotomy with total tumour removal. This example highlights the significance of identifying variations from a patient's regular headache profile and shows how secondary cerebral disease can pass for chronic migraine[2][3]. Even though they are uncommon, tentorial meningiomas can just cause headaches until a significant mass effect appears[4]. In this instance, prompt diagnosis and effective surgical care were made possible by early detection of red-flag symptoms. When headache symptoms change, don't improve with treatment, or show signs of elevated intracranial pressure, clinicians should keep a high index of suspicion and seek appropriate neuroimaging[5][6].