Confusional migraine is an adult as well as a childhood disease

Abstract

Background: Acute confusional migraine (ACM) is considered a rare migraine variant primarily seen in children and adolescents. Patients and Methods: We present a series of eight adults and two adolescents suffering from migraine attacks associated with transient confusional states. Results: Eight patients reported two or more such attacks. One of them reported mild head trauma in the past. One patient reported mild head trauma as a possible trigger. Further investigations were unremarkable in all patients and did not suggest underlying structural abnormalities, epilepsy or cerebrovascular disease. In none of these patients did we find another cause to explain the observed phenomenon. Conclusions: Based on this series of patients, we suggest expanding the concept of confusional migraine from the paediatric population to adults. The temporal course of the confusion as well as the association with visual and other aura symptoms suggest cortical spreading depression as the underlying pathophysiology.

‘Possessed’: Acute Confusional Migraine in an Adolescent, Prevented by Topiramate

“…However, the ictal EEG abnormalities were typical of ACM and persisted after the disappearance of clinical symptoms, as previously reported [2]. The high-voltage, polymorphic delta activity was prevalent in the frontotemporal regions, in agreement with the clinical features of confusion, amnesia and agitation and the supposed transient dysfunction of temporobasal and frontal cortical structures, due to cortical spreading depression [2, 3, 4, 5, 6, 7]. …”

“…Indeed, in a recent series of 8 adults and 2 adolescents suffering from migraine attacks associated with transient confusional states, only a minority of patients reported 3 or more such attacks, although the length of the follow-up was variable and limited to a few months in some cases [3]. …”

“…While neuroradiological examinations and routine laboratory tests are usually unremarkable, ictal EEG is characterized by marked, diffuse slowing and, at times, by a FIRDA pattern [2]. Based mainly on functional neuroimaging studies, cortical spreading depression is currently hypothesized as the pivotal pathophysiological mechanism [3]. ACM is reported in a low percentage (0.45) of migraineurs referred to pediatric neurology outpatient divisions [4].…”

Migraine variants and unusual types of migraine in childhood

“…Die akute konfusionelle Migräne (ACM) wird im Erwachsenenalter nur vereinzelt beobachtet [29], aber auch unter pädiatrischen Migränepatien-ten ist sie sehr selten. Jungen sind 3-bis 6-mal häufiger betroffen als Mädchen.…”

“…Der Pathomechanismus der akuten konfusionellen Migräne ist unklar, sie kann aufgrund des Zeitverlaufs und der Assoziation zu Migräneauren am ehesten durch eine "cortical spreading depression" (CSD) erklärt werden [29]. Andere Autoren ordnen die ACM einer Migräne vom Basilaristyp oder einer hemiplegischen Migräne zu, die Zuordnung zur Migräne vom Basilaristyp ist nicht unstrittig, handelt es sich doch bei der Konfusion nicht um eine eigentliche Bewusstseinsstörung [48].…”