Migraine Variants in Children
There are several disorders that have close ties to migraine, although they fool us because they do not always appear to be much like the migraine headache as we know it. These are called migraine variants and they often occur in children. When migraine variants occur, they may be confused with other health conditions, and it is not uncommon for several different other health conditions to be considered during while searching for the correct diagnosis. The three most-common variants are:
- Abdominal Migraine
- Benign Paroxysmal Vertigo
- Cyclic Vomiting Syndrome
Abdominal migraine is often associated with stomach pain instead of head pain. The pain is often diffuse across the abdomen and can be crampy, dull or sharp in nature that can last between 1-72 hours if untreated or treated unsuccessfully. The pain may be midline in location, moderate or severe in intensity, surrounding the bellybutton, and not clearly localized. Pain can be severe enough to interfere with normal daily activities. There may be loss of appetite, nausea, and/or vomiting associated, loss of pallor, photophobia or phonophobia. Children may find it difficult to distinguish anorexia from nausea. The history and physical examination will not show signs of gastrointestinal or renal disease. Some children will have headache as well as abdominal pain. Most children with abdominal migraine will eventually develop migraine headache later in life.
Benign Paroxysmal Vertigo
Benign Paroxysmal Vertigo occurs usually in toddlers or young children. The child will suddenly become unsteady or off-balance and refuses to walk. They may appear pale or sick and are usually irritable or fussy. They often want to be held and when placed down to walk, they will either refuse or be very wobbly on their feet, walking with feet spread wide apart, as if they were drunk. Benign paroxysmal vertigo is often associated with nystagmus or vomiting; unilateral throbbing headache may occur in some attacks. The attack lasts from a few minutes to hours and often resolves with sleep. Between attacks, the child is perfectly normal. Since the attacks are usually brief and infrequent, often no treatment is needed. These children will have a normal electroencephalogram.
Cyclic Vomiting Syndrome
Cyclic vomiting syndrome also occurs in school-age children. This condition consists of episodes of vomiting. There may be associated abdominal pain, headache, photophobia or phonophobia. The vomiting is usually quite forceful and frequent and occurs 4-5 times each hour for at least 1 hour. These episodes may last from 1 hour or up to 5 days. Often, attacks occur in a pattern so families can predict when an attack may occur. Attacks may begin in the early morning hours and may be severe enough to cause dehydration. Attacks can be severe enough to require emergency room visits for rehydration and if frequent enough, migraine preventive medications may be used to decrease the frequency and severity of attacks. History and physical examination do not show signs of gastrointestinal disease.
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