Confusional migraine in childhood

The aim of this retrospective study was to analyze data obtained from cases with acute confusional migraine and compare them with those of other series. Data were abstracted from files of 76 patients with a discharge diagnosis of migraine admitted to British Columbia Children's Hospital, Vancouver, Canada, between January 1982 and September 1990. Of the 76 patients, 13 manifested confusional migraine (ratio of males to females was 11:2). The age ranged between 6 and 15 years (mean age 10.8 years). All patients reported headache and confusion. The duration of confusion was 2-24 hours. Other findings included a positive history of mild head trauma (4 patients), agitation (8 patients), past history of headache (7 patients), family history of migraine on the maternal side (10 patients), and history of migraine on both sides of the family (1 patient). CT scans were performed on 11 patients; 10 were reported to be normal, and 1 patient presented an arachnoid cyst. EEGs performed on 4 patients disclosed mild abnormality in 2. Cerebrospinal fluid, studied in 2 patients, was normal. Management of a child with confusional migraine must take into consideration underlying causes, such as seizures, encephalitis, and substance abuse.