Differentiating arterial ischaemic stroke from migraine in the paediatric emergency department

Mackay, Mark T; Lee, Michelle; Yock‐Corrales, Adriana; Чурилов, Леонид; Donnan, Geoffrey A.; Monagle, Paul; Babl, Franz E

doi:10.1111/dmcn.13772

Cited by 24 publications

(18 citation statements)

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“…In sporadic hemiplegic migraine, motor symptoms develop gradually over minutes, affecting more often the arm than the leg (while sparing the face). They can be bilateral and are primarily associated with headache (40). Another useful element is that children with arterial ischemic stroke (AIS) are older than those with migraine, and considered at risk (red flag) up to 8 years of age (40).…”

Section: Primary Headachementioning

confidence: 99%

Management of Childhood Headache in the Emergency Department. Review of the Literature

et al. 2019

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Headache is the third cause of visits to pediatric emergency departments (ED). According to a systematic review, headaches in children evaluated in the ED are primarily due to benign conditions that tend to be self-limiting or resolve with appropriate pharmacological treatment. The more frequent causes of non-traumatic headache in the ED include primitive headaches (21.8–66.3%) and benign secondary headaches (35.4–63.2%), whereas potentially life-threatening (LT) secondary headaches are less frequent (2–15.3%). Worrying conditions include brain tumors, central nervous system infections, dysfunction of ventriculo-peritoneal shunts, hydrocephalus, idiopathic intracranial hypertension, and intracranial hemorrhage. In the emergency setting, the main goal is to intercept potentially LT conditions that require immediate medical attention. The initial assessment begins with an in-depth, appropriate history followed by a complete, oriented physical and neurological examination. The literature describes the following red flags requiring further investigation (for example neuroimaging) for recognition of LT conditions: abnormal neurological examination; atypical presentation of headaches: subjective vertigo, intractable vomiting or headaches that wake the child from sleep; recent and progressive severe headache (<6 months); age of the child <6 years; no family history for migraine or primary headache; occipital headache; change of headache; new headache in an immunocompromised child; first or worst headache; symptoms and signs of systemic disease; headaches associated with changes in mental status or focal neurological disorders. In evaluating a child or adolescent who is being treated for headache, physicians should consider using appropriate diagnostic tests. Diagnostic tests are varied, and include routine laboratory analysis, cerebral spinal fluid examination, electroencephalography, and computerized tomography or magnetic resonance neuroimaging. The management of headache in the ED depends on the patient's general conditions and the presumable cause of the headache. There are few randomized, controlled trials on pharmacological treatment of headache in the pediatric population. Only ibuprofen and sumatriptan are significantly more effective than placebo in determining headache relief.

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Section: Primary Headachementioning

confidence: 99%

Management of Childhood Headache in the Emergency Department. Review of the Literature

et al. 2019

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“…From the point of view of an adult neurologist, the paediatric population exhibits a relatively low frequency of stroke and a high frequency of stroke mimics . Migraine (particularly with aura) is the most common cause of stroke‐like symptoms in children . The diagnosis of migraine remains clinical, whereas that of AIS is based on both clinical symptoms and neuroimaging.…”

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confidence: 99%

“…Mackay et al . evaluated the strengths of association between clinical features and migraine or AIS in children.…”

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confidence: 99%

“…1 Migraine (particularly with aura) is the most common cause of stroke-like symptoms in children. 2 The diagnosis of migraine remains clinical, whereas that of AIS is based on both clinical symptoms and neuroimaging. Moreover, if migraine and stroke differ with regards to sex preponderance, age of onset, and clinical presentation, the association of the two conditions is known, particularly in younger patients.…”

mentioning

confidence: 99%

“…CADASIL and MELAS). 3 Mackay et al 2 evaluated the strengths of association between clinical features and migraine or AIS in children. They found motor signs, speech disturbance, and walking impairment to be evocative of AIS; whereas headache, visual, and other sensory symptoms were more related to migraine with aura.…”

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confidence: 99%

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