What is the role of lab tests 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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Answer

Laboratory studies generally are not helpful between episodes when the patient has a history of multiple, recurrent episodes and complete clearing between episodes. Evaluate a child with cyclic vomiting with or without head pain for metabolic disease, particularly mitochondrial cytopathy.

Studies performed during attacks have higher yield than those performed while the child is feeling well. During the attack, perform the following investigations:

  • Serum lactate

  • Serum pyruvate

  • Urine organic acids

  • Serum ammonia

Samples must be collected carefully and handled appropriately by the laboratory. If suspicion of mitochondrial cytopathy is high, blood may be collected at any time to allow examination of the DNA for mitochondrial point mutations and deletions.

For families who appear to have clusters of symptoms including hemiplegic migraine, with or without epilepsy, paroxysmal dyskinesias and/or episodic ataxia, whole exome sequencing may be able to find the specific genetic cause. Additionally, the use of genetic panels that include sequencing of genes associated with specific symptoms (such as epilepsy or autism) have faster turn arounds, lower costs, and the yields can be similar to whole exomes.


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