Which clinical history findings are characteristic of confusional migraine in children?

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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Although confusional migraine is more common in younger children, it sometimes presents in postpubertal adolescents or adults. Occasionally, a child whose episodes began in the prepubertal years continues to have episodes into adolescence. The child has a period of confusion and disorientation, with or without agitation, followed by vomiting, which is relieved by sleep. Headache may not be prominent or may be elicited only retrospectively.

So-called "Alice-in-Wonderland syndrome" may be a special case of confusional migraine. The patient subjectively experiences the sensation of their own body being either larger or smaller than normal, and objects and people around them appearing larger or smaller, combining both somesthetic and visual perceptual disturbances. The same clinical syndrome can also be associated with a variety of viral illnesses, including influenza and EBV infection, but if it occurs repeatedly may be a migraine aura. [18]

Making the diagnosis during the first episode is difficult; it is possible only after the episode has resolved fully. Acute differential diagnosis of a single episode includes all types of encephalopathy or encephalitis, toxic ingestion, intoxication, and an unobserved seizure with postictal agitation.

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