Expert Opinion A Left Frontal Secretory Meningioma Can Mimic Transformed Migraine With and Without Aura Randolph W. Evans, MD; Josefine S. Timm, MD; David S. Baskin, MD, FACS, FAANS Key words: secretory meningioma, transformed migraine, chronic migraine, migraine with aura, brain tumors, neuroimaging (Headache 2015;55:849-852) Of all the migraine mimics, 1 some patients are especially anxious about the possibility of brain tumors as the cause of their chronic migraines. 2 Is there reason for concern? CASE HISTORY This is a 47-year-old female with headaches that had been occurring daily for 2 months and prior twice a week for 1 year. She described a bifrontal throbbing with an intensity of 2-4/10 associated with nausea at times, light and noise sensitivity, but no vomiting. She would take acetaminophen, and the headache would last a couple of hours. For the prior 3 months, every few days, she would see the edge of a broken glass flashing on and off in the right field of vision, which would be small, expand, and then break up.The visual changes would last about 30 minutes. They began before the headache and resolved as the headache was starting. Stress was a trigger for the headaches. She had a prior history of a different type of headache since her teens that had occurred once a week described as a pressure on the sides, as well as the occipital and bifrontal areas with an intensity of 2/10. (The headaches were described in a prior office visit 2 years earlier when seen for myofascial neck pain by one of the coauthors, R.W.E.) There was no nausea/vomiting, light or noise sensitivity, or aura. She took acetaminophen with relief in 1-2 hours. There was a past medical history of hypothyroid- ism, hyperlipidemia, and depression (on fluoxetine 40 mg daily for several years). Neurological exam was normal. Magnetic resonance imaging (MRI) of the brain showed a 3 × 2.5 × 2.5 cm left medial anterior inferior frontal extra-axial dural-based homogenously enhancing mass with vasogenic edema, marked mass effect on the left frontal horn, and anterior corpus callosum, and 16-mm subfalcine herniation from left to right (Figs. 1 and 2). When completely resected 3 weeks later, the pathology was a secretory menin- gioma. Postoperative MRI scans showed no residual tumor. From the Department of Neurology, Baylor College of Medi- cine, Houston, TX, USA (R.W. Evans); Neuroradiology, Houston, TX, USA (J.S. Timm). Neurosurgery Residency Training Program, Department of Neurological Surgery, Meth- odist Neurological Institute, Houston, TX (D.S. Baskin); Neurological Surgery, Weill Medical College, Cornell University, New York, NY (D.S. Baskin); Houston Methodist Kenneth R. Peak Brain & Pituitary Tumor Treatment Center (www.houstonmethodist.org/peakcenter), Houston, TX, USA (D.S. Baskin). Neuroradiology. Address all correspondence to R.W. Evans, Department of Neurology, Baylor College of Medicine, 1200 Binz #1370, Houston, TX 77004, USA, email: revansmd@gmail.com. Accepted for publication March 23, 2015. ISSN 0017-8748 doi: 10.1111/head.12580 Published by Wiley Periodicals, Inc. Headache © 2015 American Headache Society 849