Spectrum of complicated migraine in children: A common profile in aid to clinical diagnosis

Abstract

Complicated migraine encompasses several individual clinical syndromes of migraine. Such a syndrome in children frequently presents with various neurological symptoms in the Emergency Department. An acute presentation in the absence of headache presents a diagnostic challenge. A delay in diagnosis and treatment may have medicolegal implication. To date, there are no reports of a common clinical profile proposed in making a clinical diagnosis for the complicated migraine. In this clinical review, we propose and describe: (1) A common clinical profile in aid to clinical diagnosis for spectrum of complicated migraine; (2) How it can be used in differentiating complicated migraine from migraine without aura, migraine with aura, and seizure; (3) We discuss the status of complicated migraine in the International Headache Society classification 2013; and (4) In addition, a common treatment strategy for the spectrum of migraine has been described. To diagnose complicated migraine clinically, it is imperative to adhere with the proposed profile. This will optimize the use of investigation and will also avoid a legal implication of delay in their management. The proposed common clinical profile is incongruent with the International Headache Society 2013. Future classification should minimize the dissociation from clinically encountered syndromes and coin a single word to address collectively this subtype of migraine with an acute presentation of a common clinical profile.

Keywords: Complicated migraine; Electroencephalography; Magnetic resonance imaging; Seizure; Seizure like activity; Stroke.

Figure 1

Coronal fluid-attenuated inversion recovery weighted image in a 15-year-old male with previous diagnosis of migraine with aura revealed the left parietal lobe arteriovenous malformations. This was suspected based upon a history of slowly evolving prolonged right hemisensory cutaneous aura. Onset of a new condition in migraine simulates the previous migraine attack. Implication of missing or delay in diagnosis of the second condition can be prevented by differential thinking regarding mixed sympotomatology of both conditions.