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Migraine Headache in Children (cont.)

Migraine Headache Types

Migraine with aura: This type of migraine, also known as classic migraine, is characterized by a visual or other type of aura followed by a unilateral (one-sided), throbbing headache, which may later spread to both sides. It lasts from half an hour to 48 hours. Migraine with aura occurs in 15% to 40% of children who experience migraine headaches. The typical aura is manifested by various abnormalities of the visual, auditory, and/or sensory systems. These symptoms are progressive in intensity, usually last for about 1 hour, and resolve completely.

Common migraine: Common migraines lack an aura. Migraine without aura in children is traditionally described as a recurring (happening over and over), bilateral (two-sided) headache disorder with a throbbing and/or pulsating pain quality, moderate-to-severe intensity, and severe stomach symptoms. Common accompanying symptoms in children are irritability and paleness with dark circles under the eyes. In younger children, the pain is more often on both sides and around the eyes and temples. Migraine without aura occurs in 60% to 85% of migrainous children.

Chronic migraine: Persons with chronic migraine have headache attacks at least 15 days of every month for at least 2 months. Chronic migraine may affect up to 4% of teenage girls and 2% of teenage boys.

Status migrainosus: This is a severe form of migraine headache in which the attack is continuous over 72 hours. People who have such an attack usually have a history of migraine. In those who vomit, rehydration (restoring adequate fluid levels) is often the necessary first step in treatment.

Complicated and variant migraines: These are classified as migraines because they often have the same triggers. They are brief, recurrent, episodic disorders that are made worse by physical activity and relieved by deep sleep or typical anti-migraine medications.

Complicated and variant migraines cause some of the same symptoms as typical migraines, including pain, stomach problems, autonomic symptoms (for example, abnormal sweating, changes in pupil size), neurologic symptoms (for example, tingling, numbness, weakness), and changes in mood or emotion. These benign (relatively harmless) disorders are frightening because they often seem to be life-threatening emergency situations.

Migraine equivalents are under-recognized and under-reported expressions of childhood migraine. They are often forerunners of the typical migraine, and complicated and variant migraines occasionally alternate with typical migraines.

Listed below are examples of some of these variant migraine patterns.

  • Familial hemiplegic migraine (FHM): FHM is an uncommon form of migraine with aura. Persons with FHM have long-lasting hemiplegia (paralysis of one side of the body) along with numbness, aphasia, and confusion. The hemiplegia may come before (as part of the aura), accompany, or follow the headache, and symptoms may last for hours or as long as a week. FHM is very rare and may run in families (usually another first- or second-degree relative is affected in these cases).
    • The headache is usually opposite from the paralyzed side. Some cases of FHM are associated with cerebellar ataxia [a loss of muscle coordination caused by disorders of the cerebellum (a part of the brain)]. People with other types of severe FHM may experience coma, fever, and meningismus [pain caused by irritation of the membrane layers (meninges) surrounding the brain and spinal cord].
    • Another type of FHM involves progressive ataxia, nystagmus (uncontrollable, rapid horizontal or vertical movement of the eyeballs), clumsiness, and dysarthria (a speech disturbance due to emotional stress, to brain injury, or to paralysis, incoordination, or spasticity of the muscles used for speaking). A chromosomal marker has been demonstrated to be shared with patients who experience FHM. The significance of this observation is not fully understood.
  • Basilar migraine (basilar artery migraine or Bickerstaff syndrome): Basilar migraine is a subtype of migraine with aura that is mostly observed in adolescent and young adult females. The headache pain is located in the back of the head. The headache must have at least two of the aural symptoms and signs listed below:
    • Ataxia
    • Bilateral paresthesias (abnormal feeling of burning, pricking, tickling, tingling, etc., on both sides of the body)
    • Deafness
    • Decreased level of consciousness
    • Diplopia (double vision)
    • Dizziness
    • Drop attacks (atonic seizure)
    • Dysarthria
    • Fluctuating low-tone hearing loss
    • Tinnitus [noises (ringing, whistling, hissing, roaring, etc.) in the ear]
    • Unilateral (one-sided) or bilateral (two-sided) vision loss
    • Vertigo
    • Weakness
Medically Reviewed by a Doctor on 3/7/2013

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