Unraveling Intractable Headache in Acute Myeloid Leukemia With Coexisting Migraines and Chiari Malformation.

The role of acute myelogenous leukemia (AML) in affecting the central nervous system (CNS) is not well-defined, with reported incidence rates varying widely. Central nervous system involvement is typically regarded as rare during the initial stages of AML. We present a case of a 28-year-old woman who had AML with CNS infiltration that manifested as a complex presentation of persistent headaches in the context of multiple confounding factors, including a history of intractable migraines, recent discontinuation of Erenumab, elevated risk of idiopathic intracranial hypertension due to a body mass index of 45, and worsening herniation of a Chiari I malformation. Notably, the patient lacked the typical imaging features usually associated with CNS leukemia. This case highlights the need for proactive assessment of CNS involvement in AML patients who carry high-risk mutations and present with neurological symptoms. It further highlights the importance of having a high index of suspicion for CNS disease in AML patients presenting with headaches, even in the absence of classical radiographic findings of leptomeningeal spread.