eMedicine Specialties > Neurology > Pediatric Neurology

Childhood Migraine Variants: Follow-up

Author: Wendy G Mitchell, MD, Professor of Neurology, University of Southern California School of Medicine; Consulting Staff, Division of Child Neurology, Children's Hospital Los Angeles, Los Angeles County-University of Southern California
Contributor Information and Disclosures

Updated: Feb 5, 2009

Follow-up

Further Outpatient Care

Encourage patients and families to keep diaries of episodes, foods consumed, activities, illness, and medications. They should bring this list to follow-up visits to assist in identification of precipitants and to assess the efficacy of treatment.

Inpatient & Outpatient Medications

  • Acute abortive treatment
    • Antiemetic and/or sedatives
    • Minor analgesics
    • Ergotamines
    • Triptans
    • Fluid replacement, if vomiting is severe
  • Chronic prophylactic treatment is indicated if episodes are frequent, disruptive, and/or the patient and/or family desire treatment and are ready to comply with daily medication.
    • Beta-blockers
    • Tricyclic antidepressants
    • Aspirin (minidose)
    • Anticonvulsants
    • Cyproheptadine
    • High-dose vitamin B-2 (Riboflavin) combined with high doses of magnesium salts (usually magnesium oxide or citrate)

Complications

  • Risk of stroke is higher in migraineurs, and patients with hemiplegic migraine may be at even higher risk.
  • Abdominal migraine (cyclic vomiting syndrome) may cause significant dehydration.

Prognosis

Migraine variants may cause significant disability from loss of school time for the child, loss of work time for parents, and general disruption of family function.

Patient Education

Miscellaneous

Medicolegal Pitfalls

The diagnosis of migraine and migraine variants is a clinical, based largely on a history of repeated episodes, with complete normalization between attacks. Imaging is useful only to rule out other causes, particularly in the acute setting, not to diagnose migraine or migraine variant. In an acute setting, particularly with a first attack, failure to find a serious alternative cause (eg, tumor, hemorrhage, hydrocephalus) would likely be viewed as a breach in standard of care.

  • When the patient is symptomatic and has an abnormal neurological examination, migraine variant can almost never be diagnosed unless a consistent pattern exists of similar previous events and the child has had a well-documented normal examination between events. First episodes should never be diagnosed as variant migraine without carefully ruling out other serious pathology.
  • Although alternative causes of symptoms are rare, most patients are not satisfied with a simple explanation and neuroimaging is often performed to rule out serious alternative pathology (eg, intracranial hemorrhage, tumor, hydrocephalus). If the physician decides that imaging is not indicated (eg, it has been repeatedly performed for similar attacks), the reasoning should be well documented in the medical record and a clear explanation should be given to the patient and family.

 


More on Childhood Migraine Variants

Overview: Childhood Migraine Variants
Differential Diagnoses & Workup: Childhood Migraine Variants
Treatment & Medication: Childhood Migraine Variants
Follow-up: Childhood Migraine Variants
References
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Further Reading

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Keywords

abdominal migraine, acute confusional migraine, basilar migraine, benign paroxysmal vertigo of childhood, cyclic vomiting of childhood, hemiplegic migraine, migraine, migraine aura without headache, ophthalmoplegic migraine, vascular headache, childhood migraine variants, migraine in children

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Contributor Information and Disclosures

Author

Wendy G Mitchell, MD, Professor of Neurology, University of Southern California School of Medicine; Consulting Staff, Division of Child Neurology, Children's Hospital Los Angeles, Los Angeles County-University of Southern California
Wendy G Mitchell, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, Child Neurology Society, and International Child Neurology Association
Disclosure: Questcor Honoraria Consulting

Medical Editor

James J Riviello Jr, MD, George Peterkin Endowed Chair in Pediatrics, Professor of Pediatrics, Section of Neurology and Developmental Neuroscience, Professor of Neurology, Peter Kellaway Section of Neurophysiology, Baylor College of Medicine; Chief of Neurophysiology, Director of the Epilepsy and Neurophysiology Program, Texas Children's Hospital
James J Riviello Jr, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Kenneth J Mack, MD, PhD, Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic
Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Phi Beta Kappa, and Society for Neuroscience
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD, Assistant Professor, Department of Pediatrics, Division of Pediatric Neurology, Department of Neurology, Oregon Health and Science University; Consulting Staff, Shriners Hospital for Children
Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society
Disclosure: Nothing to disclose.

 
 
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