Prolonged visual aura, late-onset migraine-like headaches, and seizures suggest an occipital arteriovenous malformation.

To report a patient with occipital arteriovenous malformation (AVM), manifested by prolonged visual aura and migraine-like headache as well as rare tonic-clonic seizures. The patient is a 55-year-old woman with a left occipital, unruptured AVM that first manifested with attacks of prolonged visual aura, followed by a migraine-like headache at the age of 32. The frequency of these attacks steadily increased over the years and at the age of 45 she experienced her first tonic-clonic seizure. The workup revealed a left occipital, unruptured AVM. She received levetiracetam (1000 mg/d), which she discontinued at the age of 53. At the age of 54 years, she suffered a second tonic-clonic seizure, but the patient continued to refuse to undergo embolization, resection, or stereotactic radiosurgery. This case demonstrates that an occipital, unruptured AVM can go undetected for years and present with late-onset, migraine-like headaches with prolonged visual aura and rare generalized seizures. Patients with late-onset, migraine-like headaches with prolonged visual aura require immediate brain imaging.