What is included in the workup of 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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During the first or worst episode, perform appropriate laboratory and neuroradiologic studies to exclude other causes of the symptoms. [20]

Although alternative causes of symptoms are rare, most patients are not satisfied with a simple explanation, and neuroimaging is often performed to rule out serious alternative pathology (eg, intracranial hemorrhage, tumor, or hydrocephalus). If the physician decides that imaging is not indicated (eg, on the grounds that it has been repeatedly performed for similar attacks), the reasoning should be well documented in the medical record, and a clear explanation should be given to the patient and the family.

For aura without headache, the differential diagnosis often includes simple partial (focal) seizures. Therefore, electroencephalography (EEG) or video EEG may help in the diagnosis. For other migraine variants, EEG generally does not confirm or exclude migraine or other alternatives, since epileptiform EEG changes can be observed in migraineurs.

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