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A 42-year-old women was referred to our pain therapy centre in April 2013 owing to a worsening migraine. She was known to have von Willebrand disease type III complicated by the development of alloantibodies to von Willebrand factor and previous anaphylactic shock during infusion of factor VIII/von Willebrand factor concentrates. The patient is being treated with a continuous infusion of recombinant factor VIII, when bleeding occurs.
Since the age of 14, the patient has received combination oestrogen and progestogen treatment to prevent the risk of bleeding related to ovulation. She has no other relevant medical history.
Migraine pain began at the start of 2007, and rapidly became severe (typically scoring 8–10 on the numerical rating scale (NRS) for a period of 72 h). The pain was treated with paracetamol, sumatriptan and rizatriptan in turn, without success. In view of her lifelong bleeding tendency, the use of non-steroidal anti-inflammatory drugs was avoided. Prophylactic therapy was started with propranolol and then with flunarizine, without benefit. The pain pattern was typical of migraine1 and …
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