Variants of migraine in children
Equivalents of migraine appear in every tenth patient with migraine in pediatric neurological practice. The most common migraine equivalent is benign paroxysmal dizziness. Such syndromes as cyclic vomiting, abdominal migraine, benign paroxysmal torticolysis, acute confusion, etc. are also common.
Diagnosis of migraine equivalents in childhood can only be made after eliminating secondary causes of symptoms. The key characteristic of these syndromes is the complete well-being of the patient during the interictal periods. Patients with migraine equivalents have no abnormalities in neurological examination, neuroimaging, and electroencephalography.
The latter is used in children suffering from paroxysmal disorders for the differential diagnosis of epilepsy and migraine. The equivalents of migraine in children are considered in cases where no abnormality is detected during the examination, but there is a family history of migraine.
In the vast majority of patients, headaches of non-traumatic etiology are of a primary nature. Identifying a combination of characteristic symptoms of headache helps to distinguish between common types of primary headaches. Migraine in children differs significantly from that in adults. It often has bilateral localization, a short duration, and less commonly manifested by adult-specific signs, such as debilitating pain and increased sensitivity to external stimuli. An important tool for the diagnosis of migraine in children is the use of questionnaires and diaries, which describe the symptoms of the disease, as well as drawings depicting the symptoms of headaches.
Key points:
• In the vast majority of cases, acute and chronic headaches in outpatients are of a primary nature, among them migraine is the most frequent.
• The newly started or changed in nature headaches with the appearance of pathological symptoms that are not amenable to effective previously medical correction, should be considered as possible secondary headaches.
• A migraine attack in adults can be divided into four stages: prodroma, aura, headache and postdromus.
• Migraine is often mistaken for “sinus” or beam headaches. • Unlike migraine in adults, migraine in children often has bilateral localization, a shorter duration and is not accompanied by “throbbing pain, light and pharynx.
• The diaries reflecting the symptoms of migraine and the image of headaches in the form of drawings help in identifying the characteristic signs of migraine in children.
• Migraine equivalents manifest as episodic non-pain disorders in infants and children.