Basilar migraine in childhood

The incidence and different presentations of basilar migraine are described in a series of 132 children (80 boys, 52 girls) presenting with recurring headache considered to be migraine. Basilar migraine occurred in 29 children, and a further 18 had minor symptoms compatible with but not diagnostic of this form. The course was most often benign, with infrequent, fragmentary attacks and little disability. Rarely, attacks were both severe and frequent, but even then the clinical pattern and outcome usually followed a similar course. Only two children (with the youngest ages at onset) have serious disability, with mental slowing and (in one) permanent neurological sequelae. The relationship between basilar migraine and the syndrome of alternating hemiplegia of infancy is discussed. Because of the limited present knowledge, it is suggested that rigid definitions of migraine should be avoided.