Acute confusional migraine in an octogenarian: A rare stroke mimic

Background Acute confusional migraine (ACM) is a rare migraine variant, primarily documented in paediatric populations. Its presentation in geriatric patients is extremely rare and can mimic acute ischemic stroke. Case We report on an 84-year-old male presenting with acute hemicrania followed by confusion and dysarthria. Despite initial systemic thrombolysis for suspected stroke, symptoms only resolved after sleep. Extensive diagnostics were unremarkable, leading to the diagnosis of ACM based on a 20-year history of stereotyped attacks. Conclusion This case represents the oldest reported patient with ACM to date. It highlights the importance of including ACM in the differential diagnosis of stroke mimics in the elderly to avoid unnecessary interventions.