Elsevier

Pediatric Neurology

Volume 26, Issue 5, May 2002, Pages 365-368
Pediatric Neurology

Original article
Pediatric migraine equivalents: Occurrence and clinical features in practice

https://doi.org/10.1016/S0887-8994(01)00416-7Get rights and content

Abstract

Migraine equivalents of infancy, childhood, and adolescence are recognized periodic, paroxysmal syndromes without associated headache that are thought to be migrainous in etiology. Five such equivalents are presently recognized. Their clinical features and relative frequency in ambulatory pediatric neurology practice have not been well documented. Utilizing a comprehensive, standardized computer database, the occurrence of these migraine equivalents in a single pediatric neurology practice together with their observed clinical features were documented over an 8-year period. Of a total of 5,848 patients in the database, of whom 1,106 were migraineurs, 108 patients (1.8% of total, 9.8% of migraineurs) were identified to have migraine equivalents. The following distribution among migraine equivalents was observed: benign paroxysmal torticollis 11 (10.2% of patients with migraine equivalents), benign paroxysmal vertigo 41 (38%), abdominal migraine/cyclical vomiting 20 (18.5%), acephalgic migraine 31 (28.7%), and acute confusional migraine 5 (4.6%). In each type, with the exception of benign paroxysmal torticollis and acute confusional migraine, females clearly predominated, and in all types a strong positive family history of migraine was elicited (68%–100%). There was variation in the age of onset of a particular equivalent with considerable overlap observed. Coexisting more typical migraines were observed in from 10% (benign paroxysmal torticollis) to 70% (abdominal migraines/cyclical vomiting) of the cases. In conclusion, pediatric migraine equivalents occur with relative frequency in ambulatory practice, possessing discrete clinical features that have a clear relationship to more typical migrainous phenomena.

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.

Section snippets

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.

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