What are the diagnostic challenges of migraine variants (equivalents)?

Updated: Oct 16, 2019
  • Author: Rima M Dafer, MD, MPH, FAHA; Chief Editor: Helmi L Lutsep, MD  more...
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Migraine variants are less recognized, less common, and less well understood than the typical migraines, both without and with aura, that usually affect children and young adults.

Affected individuals usually undergo unnecessary extensive and invasive diagnostic and laboratory evaluations before the diagnosis is made. A careful history that reveals multiple attacks with complete recovery, paroxysmal signs and symptoms with or without cephalalgia, migraine with aura—all in the absence of other medical disorders that may contribute to the symptoms—as well as a symptom-free period between attacks and a family history of migraine or a similar disorder, is usually helpful in confirming the diagnosis.

Migraine variants should be differentiated from trigeminal autonomic cephalalgias (including cluster headaches, paroxysmal hemicrania, and syndrome of neuralgiform conjunctival injection and tearing), as well as from other primary headache disorders (eg, stabbing headache, thunderclap headaches, hypnic headaches, and hemicrania continua) and primary headache syndromes associated with physical activity (eg, exertional headaches, cough headaches, and headaches associated with sexual activity).

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