Acute Confusional Migraine: Case Reports and Discussion as a Distinct Entity.

Area of Science:

• Neurology
• Neuroscience

Background:

• Acute confusional migraine (ACM) is a rare migraine variant characterized by confusion, disorientation, and altered mental status.
• ACM is not currently included in the International Classification of Headache Disorders (ICHD-3 β), despite existing case reports and proposed classifications.
• Awareness of ACM is crucial for clinicians to differentiate it from other severe neurological conditions like stroke, encephalitis, or epilepsy.

Observation:

• Three distinct cases of patients experiencing altered consciousness during migraine attacks are presented.
• Case 1: An 18-year-old male with visual aura followed by confusion and torpor, recovering fully within 24 hours.
• Case 2: A 30-year-old woman in puerperium with visual aura, headache, confusion, and disorientation, with complete recovery.
• Case 3: A 36-year-old woman presenting with migraine, hemiplegia, and confusion, diagnosed with familial hemiplegic migraine, recovering after 8 days.

Findings:

• All patients underwent extensive diagnostic testing, including neuroimaging (CT, MRI), lumbar puncture, and toxicology, which yielded normal results.
• Genetic testing confirmed familial hemiplegic migraine in the third patient.
• Patients received migraine-specific treatment and long-term management strategies.

Implications:

• ACM can be misdiagnosed as more severe neurological emergencies, necessitating improved clinical awareness and diagnostic criteria.
• The study proposes criteria for including ACM in the ICHD-3 β classification to standardize diagnosis and management.
• Further research is essential to enhance the understanding, diagnosis, and treatment of acute confusional migraine.