Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
A history of typical migraine exists in 86% of families studied. Many
people experience basilar migraine attacks intermingled with typical
migraine attacks. Three to 20% of children with migraine will suffer from
basilar migraine. The most common age of onset is 7 years of age.
Ophthalmoplegic migraine: This form of migraine is associated with paralysis of the extraocular muscles (muscles which control eyeball movement) and is rare. People with this type of migraine experience severe one-sided headaches. Ophthalmoplegia (paralysis of one or more of the eye muscles) may precede, accompany, or follow the headache.
Retinal migraine: This is an extremely rare migraine type during
which there is a unilateral (one-sided) sudden loss of vision preceded by a
sensation of bright lights. A migraine headache generally follows within 1 hour of the visual impairment and is commonly on the same side as the affected eye. Full vision recovery is expected; it is rare to have any permanent loss or impairment of vision.
Benign paroxysmal vertigo of childhood: This condition is probably not a true migrainous disorder. It is the most frequent cause of
vertigo in childhood and is characterized by brief episodes of vertigo, disequilibrium (poor balance), and nausea. Episodes tend to be brief, have a sudden onset, and may occur in clusters for several hours and then spontaneously stop. Children with this problem are usually aged 2
to 6 years.
Nystagmus may occur during but not between attacks.
tinnitus, or loss of consciousness does not occur. Symptoms usually last only a few minutes. Parents observe that an attack is characterized by a sudden onset of fear, refusal to walk, or need to hold onto supporting structures for stability. They may have a sudden loss of alertness ("space out"). No headache occurs in benign paroxysmal vertigo. Children with benign paroxysmal vertigo often develop a more common form of true migraine as they mature.
Acute confusional migraine: This type of migraine is characterized by short-lived episodes of amnesia (memory loss), confusion, agitation, lethargy, and dysphasia (speech difficulties) brought about by minor
head trauma. The child may have aphasia, and the confusional state may either precede or follow the headache. Some children also experience recurrent episodes of temporary amnesia and confusion. Recovery almost always occurs within
6 hours. One report points out that brain
CT studies of those whose migraine is associated with head trauma are normal. The child may not have a history of headache but usually develops typical migraine attacks at some point in the future.
cyclic vomiting syndrome (periodic syndrome): This syndrome is characterized by recurrent periods of intense vomiting separated by symptom-free intervals. Many people with cyclic vomiting have regular or cyclic patterns of illness. Symptoms usually come on quickly at night or in the early morning and last 6
to 48 hours. Associated symptoms include abdominal pain (80%), nausea (72%), retching (76%), anorexia (74%), paleness (87%), lethargy (91%), photophobia (32%), phonophobia (28%), and headache (40%).
Headache often does not appear until the child is older. Migraine-associated cyclic vomiting syndrome usually begins when the person is a
toddler and disappears in adolescence or early adulthood. (It rarely begins in adulthood.) This syndrome affects more females than males.
Infections, psychological or physical stress, and dietary triggers are often clearly associated. Examples of triggers include cheese, chocolate,
monosodium glutamate (MSG), emotional stress, excitement, or infections. Usually, a
family history of migraines in the parents or siblings is present. Children with this condition often need
Abdominal migraine: The child may have recurrent bouts of generalized stomach pain with nausea and vomiting. No headache is present. After several hours, the child can sleep and later awakens feeling better. Abdominal migraine may alternate with typical migraine and usually leads to typical migraine as the child matures. Some studies indicate that abdominal migraine may affect as many as 12% of school-aged children.
of infancy: Probably not a true migrainous condition, paroxysmal torticollis
is manifested as a sustained contraction or shortening of the neck muscles. This rare disorder is characterized by repeated episodes of head tilting and is associated with nausea, vomiting, and headache. Attacks usually occur in infants and may last from hours to days.