JUVENILE MIGRAINE, PRESENTING AS AN ACUTE CONFUSIONAL STATE

Abstract

In the literature, complicated migraine usually connotes paroxysmal unilateral headache and vomiting associated with neurological signs, such as hemiplegia, hemianopsia, aphasia, ophthalmoplegia, or syncope. A not uncommon form of complicated migraine in childhood is the presentation with an acute confusional state. Four cases are described. Emphasis is placed on the initial presentation with disturbed sensorium and consciousness, with varying degrees of agitation, and the difficulty for the clinician in distinguishing from other causes of acute mental disturbance, such as toxic-metabolic psychoses due to drug ingestion or known metabolic disease, encephalitis, acute toxic encephalopathy, and epilepsy, particularly petit mal status and postictal confusion. The diagnosis of migraine was made only after the acute episode, when the usual clinical criteria for making a diagnosis of migraine was established in retrospect or by subsequent course. In all cases the episodes of confusion were single ones, with no repetition of similar attacks, although the classic or common types of migraine often reoccurred.