Child Neurology: Migraine with aura in children

Abstract

The differential diagnosis for an acute hemiparesis in a child includes stroke, Todd paralysis, and hemiplegic migraine. In the context of an illustrative case, this review highlights the differences in clinical presentation among these entities and an approach to the diagnostic workup. Migraine with aura in children is reviewed, including migraine equivalents such as abdominal migraine and the particular presentation of hemiplegic migraine. An approach to the prophylactic and acute treatment for children with migraine with aura is offered. Neurology ® 2010;75:e16 -e19 CASE: PART 1 A 14-year-old boy with Crohn disease was admitted for a presumed flare. On the second hospital day, his abdominal pain acutely increased. Shortly thereafter, he experienced tingling starting in his shoulder and spreading over his left hemibody over 10 seconds. This was accompanied by 7/10 pounding left-sided head pain. Several minutes later, the tingling gave way to diminished sensation and weakness on the left. These symptoms persisted into the next morning, at which time a neurologic consultation was requested. Now 20 hours into the attack, he had 5/10 pounding head pain. Neurologic examination revealed a left hemiparesis in a pyramidal distribution, with face and arm affected more than leg. Sensation was also diminished over the left face and hemibody. Reflexes were normal and there was no neglect. Complete blood count, electrolytes, erythrocyte sedimentation rate, liver function tests, lactate, amylase, and lipase were normal.

Altered Cortical Activation in Adolescents With Acute Migraine: A Magnetoencephalography Study

“…9,25,26 Migraine sufferers are typically hypersensitive to multiple stimuli, including visual (photophobia), auditory (phonophobia), and sensory (cutaneous allodynia) stimuli during migraine attacks. 10,16,31 The pain of many migraine sufferers worsens with physical activity. 12,13 The exact neurobiological mechanisms of migraine expression remain speculative.…”

Therapy of migreni's drugs

“…2, мають свої власні діагностичні критерії [1]. У дітей напади мігрені можуть бути коротше (тривалістю всього 1 або 2 години) [5][6][7].…”

Abstracts and Citations

“…I would be irresponsible if I didn't also remind that migraine‐like aura can be due to focal cerebral ischemia 5 . While it is another discussion to discuss secondary headache mimicking migraine aura, let me briefly indicate that no “classic” aura symptoms assures primary headache and secondary headache must be thought of with no headache occurrence, very short or prolonged duration, highly stereotypical aura, subacute increase or new/change in very long standing aura patterns, abnormal exam, older age, or presence of seizures (remember SNOOP 4 ). 5 Reading the paper will offer many more specifics into migraine aura in this population .…”