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Updated: Feb 14, 2026
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Published on: August 11, 2021
Insights
Pediatric migraine variants differ from adult migraines, often presenting without headache and including conditions like cyclic vomiting. These diagnoses require exclusion through extensive evaluation by pediatric specialists.
Area of Science:
- Pediatric Neurology
- Gastroenterology
Background:
- Pediatric migraine manifestations can differ significantly from adult presentations.
- Migraine variants in children may not include headache, presenting as cyclic vomiting or abdominal migraine.
- These symptoms are often misdiagnosed as gastrointestinal disorders or conversion reactions.
Purpose of the Study:
- To differentiate pediatric migraine variants from adult migraines.
- To discuss complicated migraines and episodic syndromes in children.
- To emphasize the diagnostic challenges and the importance of exclusion in pediatric migraine diagnosis.
Main Methods:
- Review of clinical presentations of pediatric migraine variants.
- Discussion of diagnostic criteria and differential diagnoses.
- Emphasis on the role of pediatric neurologists in evaluation.
Main Results:
- Pediatric migraine variants include cyclic vomiting and abdominal migraine, often without headache.
- Complicated migraines present with focal neurological symptoms.
- Episodic syndromes, like trauma-triggered migraine, remain ambiguous.
- Diagnosis is primarily by exclusion after thorough evaluation.
Conclusions:
- Pediatric migraine has unique presentations requiring specialized diagnostic approaches.
- Accurate diagnosis of pediatric migraine variants relies on excluding other conditions.
- Pediatricians and neurologists play crucial roles in identifying and managing these complex cases.
Abstract:
Migraine in children can manifest in ways that are markedly different from adult migraines. In children, migraine variants are often unaccompanied by headache and include conditions such as cyclic vomiting and abdominal migraine. Children who experience these conditions are often thought to have a disorder of the gastrointestinal tract, and when evaluation is unremarkable they may be diagnosed as having a conversion reaction. Complicated migraines, on the other hand, are often accompanied by focal neurological symptoms such as ataxia, hemiparesis, or altered level of consciousness that evoke great consternation in the examining clinician. Certain episodic syndromes that may hold interest to pediatricians are also discussed in this article, mostly to emphasize the ambiguity that still surrounds these disorders, such as migraine triggered by trauma. The cardinal rule that most of these disorders are diagnoses of exclusion and can only be confirmed after extensive evaluation, either by the pediatrician or pediatric neurologist, is emphasized. [Pediatr Ann. 2018;47(2):e50-e54.].
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