Excerpt from Childhood Migraine Variants

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Background

Migraine in children may be similar to adult presentations and 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. Migraine may present with prominent nonheadache symptoms in young children (migraine without headache), or neurologic symptoms (aura) may be much more prominent than the headache.

Various recognized childhood syndromes assumed to be pathophysiologically related to migraine include benign paroxysmal vertigo of childhood, abdominal migraine, cyclic vomiting of childhood, and acute confusional migraine (acute confusional state). Basilar migraine (particularly in adolescent girls) may present with prominent dizziness and near-syncope and/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.

Pathophysiology

Although migraine and variants of migraine have long been assumed to have a vascular etiology, increasing evidence points to underlying primary neurologic causes. Some forms of migraine are genetic. Specific markers on chromosome 19 were found in some families with hemiplegic migraine.

Mitochondrial abnormalities, either from autosomal or mitochondrial DNA, may contribute particularly to the cyclic vomiting syndrome.

Sex

• In contrast to female predominance in adults, the overall frequency of migraine headaches in childhood is slightly higher in boys than in girls.
• Frequency of migraine variants is not known to vary between the sexes.

Age

Benign paroxysmal vertigo of childhood, sometimes considered a migraine variant, generally presents in toddlers.

Acute confusional migraine generally presents in the elementary school years. Less commonly, children can present either in the preschool years or in early adolescence. First attacks during the postpubertal teenage years are rare, although episodes may continue beyond puberty.

Hemiplegic migraine may present in early childhood. Basilar migraine, particularly with syncope, often presents in the early teenage years.

Please click here to view the full topic text: Childhood Migraine Variants