Migraine Variants and Precursors in Childhood: Clinical Features, Diagnostic Challenges, and Management Approaches

Migraine variants in childhood present with diverse and often nonheadache symptoms, complicating diagnosis and management. This review aims to clarify the clinical features, differential diagnoses, and therapeutic strategies for pediatric migraine variants and precursors, including infantile colic, benign paroxysmal torticollis, recurrent vertigo, cyclic vomiting syndrome, abdominal migraine, acute confusional migraine, and Alice in Wonderland syndrome. A narrative approach was used, integrating case-based discussion and current diagnostic criteria. Key findings highlight the paroxysmal nature of these syndromes, frequent family history of migraine, and the importance of excluding other causes. Most migraine variants are self-limited and benefit from supportive care, trigger avoidance, and age-appropriate pharmacologic prophylaxis when indicated. Early recognition and reassurance are essential in preventing unnecessary investigations and improving outcomes. This review underscores the need for clinician awareness and individualized management to optimize care for children with migraine variants.