What are childhood migraine variants (equivalents)?

Updated: Nov 19, 2019
  • Author: Wendy G Mitchell, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA  more...
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Presentations of migraine in children may be similar to adult presentations and may include headache, with or without aura, accompanied by nausea, vomiting, photophobia, and relief with sleep. However, several variations of migraine are unique to children and rarely if ever occur in adults. In young children, migraine may present with prominent nonheadache symptoms (migraine without headache, or acephalalgic migraine), or neurologic symptoms (aura) may be much more prominent than the headache.

Previously called "childhood periodic syndromes that are commonly precursors of migraine" in International Headache Classification of Headache Disorders (ICHD)-II, these disorders were renamed "episodic syndromes that may be associated with migraine" in ICHD-3. [1]  Although historically noted to occur in childhood, they may also occur in adults.

Recognized childhood syndromes assumed to be pathophysiologically related to migraine include the following:

  • Benign paroxysmal vertigo of childhood

  • Abdominal migraine

  • Cyclic vomiting of childhood

  • Acute confusional migraine (acute confusional state)

  • Paroxysmal torticollis

  • Infant colic (epidemiologic association with migraine)

Basilar migraine (particularly in adolescent girls) may present with prominent dizziness and near-syncope or syncope, with or without a subsequent headache. Hemiplegic migraine (usually an autosomal dominant disorder) may present in early childhood and occasionally may continue into adulthood. Ophthalmoplegic migraine also may occur in childhood.

Evidence suggests that infant colic may be an early-life expression of migraine. Epidemiologic associations are found between both infant colic and later migraine in the child, and maternal migraine. [2, 3]

Migraine variants may cause significant disability from loss of school time for the child, loss of work time for parents, and general disruption of family function.

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