Original articlePediatric migraine equivalents: Occurrence and clinical features in practice
Introduction
Migraine and its variants are frequent causes for referral for neurologic assessment in pediatric patients [1]. Over the latter half of the twentieth century, clinicians have recognized discrete migraine syndromes occurring in infancy, childhood, and adolescence that lack a prominent headache component [2], [3]. These specific syndrome complexes have been labeled migraine equivalents, migraine precursors, or periodic syndromes of childhood [3]. They are thought to bear a pathogenetic and causal relationship to more typical childhood migraines by their paroxysmal or periodic nature, similarity to more well-established adult migraine syndromes, backdrop of a strong family history of migraines in the affected child, and the later evolution in the individual child to more typical migraines [3].
At present, five such migraine equivalent syndromes have been generally recognized in pediatric patients: benign paroxysmal torticollis [4], benign paroxysmal vertigo [5], abdominal migraine/cyclical vomiting [6], acephalgic migraine [7], and acute confusional migraine [8]. The literature on these migraine equivalent syndromes largely consists of case reports and series limited to a description of each of the recognized subtypes on its own. There are no reports yet on their relative frequency of occurrence within the context of ambulatory pediatric neurology practice and their frequency within the context of migraines encountered as a whole. In addition, summarizing, comparing, and contrasting the clinical features observed for each subtype in a single series will both provide refinement of their individual clinical recognition and illustrate their individual distinctiveness along the migraine spectrum.
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Materials and Methods
Patients were identified through systematic review of a comprehensive standardized computer database of the ambulatory general pediatric neurology practice of a single pediatric neurologist (M.S.). The database includes demographic, diagnostic (neurologic and nonneurologic), and treatment information on all patients observed in the context of this practice. Information is entered into the database by the neurologist at the time of initial assessment and modified, as necessary, depending on
Results
A total of 5,848 patients were entered into the database for the 8-year inclusive period that was the time frame of the data search. A total of 1,106 migraineurs were identified, representing 18.9% of the patient population seen in the ambulatory pediatric neurology practice. A total of 108 children with a migraine equivalent were identified, representing 1.8% of all patients entered into the database and 9.8% of those identified as migraineurs. Thus approximately one in 10 of all migraineurs
Discussion
Five discrete migraine equivalent syndromes have thus far been recognized to occur within the pediatric patients. Benign paroxysmal torticollis [4], [9], [10], [11] typically is thought to begin during infancy and presents with torticollis, with or without associated pallor, vomiting, or behavioral changes. The torticollis is episodic, may occur to either side, and usually lasts between 4 hours and up to 4 days in duration. Typically the frequency and duration of these episodes decline as the
Acknowledgments
The authors would like to acknowledge the secretarial assistance of Alba Rinaldi in the preparation of this manuscript. M.I.S. is a Chercheur Boursier Clinicien (Clinical Research Scholar) of the Fonds de Recherche en Sante du Quebec. M.I.S. is grateful for the support of the MCH Foundation during the writing of this manuscript. Presented in part at the thirtieth Annual Meeting of the Child Neurology Society, Victoria, British Columbia.
References (23)
Acephalgic migraines of childhood
Pediatr Neurol
(1996)- et al.
Acute confusional migraineVariant of transient global amnesia
Pediatr Neurol
(1995) - et al.
Benign paroxysmal torticollis in infancy
Pediatr Neurol
(1993) - et al.
Benign paroxysmal torticollis of infancy
Brain Dev
(2000) Migraine as a cause of benign paroxysmal vertigo in childhood
J Pediatr
(1967)- et al.
Benign paroxysmal vertigo of childhood
Brain Dev
(2001) Confusional migraine in childhood
Pediatr Neurol
(1996)The classification and diagnosis of headache disorders
Neurol Clin
(1990)Headache. Public health problem
Neurol Clin
(1980)The expression of childhood migraine