What are the variants of pediatric migraine?

Updated: Jan 02, 2019
  • Author: J Ivan Lopez, MD, FAAN, FAHS; Chief Editor: George I Jallo, MD  more...
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Migraine variants are headaches that are accompanied by or manifested by transient neurologic symptoms. These symptoms may occur immediately before, during, or after the headache. In some situations, the headache may be mild or nonexistent.

Hemiplegic migraine and basilar artery migraine are typical examples of migraine with aura. Hemiplegic migraine, while unusual, is seen more commonly in children than in adults. This type of headache is characterized by abrupt onset of hemiparesis, which usually is followed by a headache. Hemianesthesia may also precede the headache.

Basilar artery migraines are more common in girls. They are characterized by dizziness, weakness, ataxia, and severe occipital headache (with vomiting).

Less common migraine presentations have been described in which head pain is not a prominent feature. The "Alice in Wonderland" syndrome is characterized by distortions of vision, space, and/or time. Patients may note micropsia and/or metamorphopsia, as well as other sensory hallucinations.

Confusional migraine seen in juvenile patients is characterized by impairment of sensorium, agitation, and lethargy; these impairments sometimes progress to stupor. Focal neurologic deficits, such as aphasia, anisocoria, and memory deficits, may also be seen.

Benign paroxysmal torticollis of infancy is characterized by episodes of a head tilt, and benign paroxysmal vertigo of childhood is characterized by recurrent episodes of vertigo and ataxia. The torticollis typically occurs during the first year, whereas the vertigo occurs in young children (usually aged 2-3 years).

Cyclic vomiting and recurrent abdominal pain frequently are considered migraine variants. Before diagnosing either of these entities, primary gastrointestinal (GI) diseases must be excluded.

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