eMedicine Specialties > Neurology > Pediatric Neurology
Childhood Migraine Variants: Treatment & Medication
Updated: Feb 5, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
The first step in treatment is to establish the diagnosis. When attacks have occurred on multiple occasions, with complete resolution between attacks, particularly in the presence of a positive family history of migraine, extensive laboratory evaluations and imaging can be avoided. When the child is first seen acutely, particularly during the first episode, more extensive evaluation may be necessary to exclude alternative diagnoses. Treatment can be divided into the short-term care of the specific attack and long-term medication to reduce severity or frequency of episodes. Notably, no agents have adequate clinical trials to establish safety and efficacy for either relief or prevention of migraine in preadolescent patients. All treatment is based upon weaker, often anecdotal evidence.
- Hemiplegic migraine
- Acute treatment: Antiemetics, mild sedatives, and nonnarcotic pain relievers are generally safe. However, vasoconstrictors, triptans, and ergotamine preparations are contraindicated.
- Chronic prevention: Any of the agents used to prophylax migraine have been used for hemiplegic migraines; beta-blockers, low-dose tricyclics, low-dose daily aspirin (stopping during febrile illnesses), low-dose anticonvulsants, and calcium channel blockers can be administered. Flunarizine, a calcium channel blocker not available in the US, is probably the most effective agent for true alternating hemiplegia of childhood. Nonprescription alternative agents sometimes used for prevention include high-dose riboflavin, with or without magnesium supplementation, with or without herbals (feverfew).
- Cyclic vomiting of childhood
- Acute treatment: If mitochondrial cytopathy or organic aciduria is suggested or diagnosed, tailor treatment to the underlying disorder. In general, early use of IV fluids containing adequate glucose (to prevent a catabolic state), parenteral or rectal antiemetics, and analgesics may abort the attack. Some patients respond to the triptans or ergotamine classes of medication.
- Chronic prevention: Low-dose amitriptyline can be effective. Other antimigraine agents (eg, beta-blockers, anticonvulsants, calcium channel blockers) occasionally are useful. If serum carnitine is low, consider a trial of supplementation with l-carnitine. Some patients report improvement with mitochondrial cocktails of high-dose B vitamins and coenzyme Q10. There is no firm evidence for these measures.
Consultations
If an underlying metabolic disease, mitochondrial cytopathy, or inborn error of metabolism is suggested clinically, consult with a medical geneticist with expertise in metabolic disease.
Diet
- As for all migraineurs, diet, particularly certain chemicals in food, may precipitate attacks in some patients.
- Patients should keep a detailed diary of food, activities, and episodes in an attempt to identify precipitant(s).
- Rather than embarking on elimination diets, which are unlikely to be helpful, a trial of elimination may be useful if a particular food or additive is suspected as a trigger for the attacks.
Activity
- Some migraineurs experience attacks related to specific activities or exposures.
- The most common identifiable and avoidable precipitant is glare and/or flashing lights. Encourage children who are sensitive to glare to wear sunglasses when outdoors and to avoid strobes and strobelike conditions.
Medication
Acute treatment (symptomatic therapy) terminates the particular episode. Prophylactic treatment prevents episodes or reduces the number of attacks and/or severity of episodes. Medications used to treat or abort attacks include antiemetics, ergot alkaloids, serotonin agonists, and NSAIDs. Minor analgesics, with or without antiemetics or caffeine, are useful in most children. Avoid narcotics and sedatives in most patients. Some of the prophylactic medications that are effective in some patients with migraine variants include low-dose aspirin, beta-blockers, low-dose tricyclic antidepressants, cyproheptadine, calcium channel blockers, and low-dose anticonvulsants, including valproic acid or topiramate.
Antiemetics
May be used (oral, rectal, IV) if nausea and/or vomiting are prominent.
Promethazine HCl (Phenergan)
An antiemetic and sedative available in oral, rectal, and parenteral preparations; blocks postsynaptic mesolimbic dopaminergic receptors in the brain and reduces stimuli to the brainstem reticular system.
Adult
Pediatric
<2 years: Contraindicated
>2 years: 0.25-1 mg/kg PO/PR; not to exceed 50 mg
Alternatively, 0.25-0.5 mg/kg IV/IM
May have an additive effect when used concurrently with other CNS depressants or anticonvulsants; may cause hypotension when used concurrently with epinephrine
Documented hypersensitivity; children younger than 2 y (incidences of death due to respiratory depression)
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Occasionally, patients experience paradoxic excitation; caution in patients with cardiovascular disease, impaired liver function, seizures, sleep apnea, and asthma
Metoclopramide (Reglan)
Blocks dopamine receptors in the chemoreceptor trigger zone of the CNS. Indicated for migraine-associated nausea.
Adult
Pediatric
<6 years: 0.2-0.5 mg/kg/dose
>6 years: Start with 2.5 mg; for intractable vomiting, give IV starting with 0.1-0.2 mg/kg slow push; not to exceed 10 mg
Anticholinergic agents may antagonize effects of metoclopramide; opiate analgesics may increase metoclopramide toxicity in CNS
Documented hypersensitivity; pheochromocytoma; GI hemorrhage, obstruction, or perforation; history of seizure disorders
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in history of mental illness and Parkinson disease; may precipitate dystonic reaction, which generally responds well to IV anticholinergic agent or diphenhydramine; less sedating than antiemetic doses of promethazine; if sedation and antiemetic action is needed, promethazine may be a better choice
Ergot alkaloids
Ergotamine preparations (alone or combined with caffeine) are direct vasoconstrictors of smooth muscle in cranial blood vessels. Their activity depends on the CNS vascular tone at administration. They also help establish the diagnosis. Ergot alkaloids should never be used to treat hemiplegic migraine.
Ergotamine (Cafatine, Cafergot, Cafetrate)
An alpha-adrenergic antagonist and serotonin antagonist that causes constriction of the peripheral and cranial blood vessels; effects are enhanced by caffeine.
Adult
Pediatric
<12 years: Not established
>12 years: 1-2 mg PO/SL with or without 100-200 mg caffeine
Increases effects of heparin and toxicity of nitroglycerin, propranolol, erythromycin, and clarithromycin
Documented hypersensitivity; hepatic or renal disease; sepsis; hemiplegic or ophthalmoplegic migraine; peripheral vascular disease
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
Overdose may produce substantial peripheral vasoconstriction; overuse syndromes (frequent use for daily headaches) may cause habituation and severe rebound headaches; limit administration to 1-2 times per wk; avoid prolonged regimens because of danger of gangrene
Serotonin agonists
Sumatriptan or newer varieties stimulate 5-HT1 receptors, producing a direct vasoconstrictive effect. Serotonin agonists help establish the diagnosis, but they never should be used for hemiplegic migraine. Some triptans have slightly different pharmacokinetics or adverse effect profiles, but all have substantially the same mechanism as sumatriptan. None has been adequately evaluated in children.
Sumatriptan succinate (Imitrex)
First of the new-generation antimigraine agents that directly affect 5-HT1 receptors. Selective agonist for serotonin 5-HT1 receptors in cranial arteries; suppresses inflammation associated with migraine headaches. The nasal form has been demonstrated to have some efficacy in adolescents with migraine. Other forms have no proven efficacy in children, although uncontrolled reports suggest some efficacy.
Adult
Pediatric
Use lowest effective dose
<12 years: Use cautiously in proportion to body weight
>12 years: 25-50 mg PO or 5 mg intranasally, suggested starting dose
Toxicity increases when administered concomitantly with ergot-containing drugs, selective serotonin reuptake inhibitors, and MAOIs
Documented hypersensitivity; in hemiplegic migraine, basilar artery migraine, serious congenital heart disease, significant uncontrolled hypertension, and other significant neurologic focal symptoms that accompany attacks
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Avoid frequent use because of possible rebound headaches; dysesthesias are common, while significant chest pain is rare in young patients; hypertensive crisis, coronary artery vasospasm, cardiac arrest, peripheral ischemia, and bloody diarrhea may rarely occur when administering this medication
Dihydroergotamine (DHE-45, Migranal)
Alpha-adrenergic blocking agent with direct stimulating effect on smooth muscle of peripheral and cranial blood vessels; depresses central vasomotor centers. Mechanism of action is similar to ergotamine; nonselective 5-HT1 agonist with wide spectrum of receptor affinities outside 5-HT1 system; also binds to dopamine. Thus, has alpha-adrenergic antagonist and serotonin antagonist effect. Indicated to abort or prevent vascular headache when rapid control needed or when other routes of administration not feasible.
Usually administered in conjunction with antiemetics such as metoclopramide, which is a 5-HT3-receptor antagonist and a dopamine antagonist, to treat migraine-associated nausea.
Available in IV or intranasal preparations, tends to cause less arterial vasoconstriction than ergotamine tartrate. Not FDA approved for use in children.
Adult
Pediatric
For refractory acute migraine, IV form can be titrated using adult protocol, combining titrating dose of DHE-45 with IV antiemetic to beneficial and tolerable dosing
Intranasal form is used as single dose, repeated no more than once in 30 min
Increases effects of heparin and toxicity of nitroglycerin, propranolol, erythromycin, and clarithromycin; toxicity increases if administered concomitantly with other triptans, ergotamine, or other vasoconstrictors
Documented hypersensitivity; has used sumatriptan or zolmitriptan within previous 24 h; within 2 wk of discontinuing MAOIs
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
Caution in angina, hypertension, impaired renal or hepatic function, or peripheral vascular disease; IV dosing typically causes nausea and should be preceded by IV dose of an appropriate antiemetic (eg, metoclopramide, promethazine, chlorpromazine); overuse can cause rebound headaches; excessive dose causes severe peripheral vasoconstriction with ischemia and may also cause agitation and hallucinations
Nonsteroidal anti-inflammatory agents (NSAIDs)
Most commonly used to relieve mild to moderate pain. Although effects of NSAIDs in treatment of pain tend to be patient specific, ibuprofen is usually DOC for initial therapy. In randomized trials, ibuprofen is one of the only agents with proven efficacy in pediatric migraine. Ibuprofen, sodium naproxen, or other NSAIDs, particularly if combined with or preceded by an antiemetic, may abort acute episodes.
Ibuprofen (Ibuprin, Advil, Motrin)
Inhibits pain, probably by decreasing activity of enzyme cyclooxygenase, which results in inhibition of prostaglandin synthesis.
Adult
Pediatric
<12 years: 100-200 mg PO; starting dose for pain is 4-10 mg/kg q6h
>12 years: 400-600 mg PO as tab or syr
Probenecid may increase concentrations and possibly toxicity of NSAIDs; may decrease effect of loop diuretics when administered concurrently; PT may increase when administered concurrently with anticoagulants; monitor PT and bleeding; may increase serum lithium levels and risk of methotrexate toxicity
Documented hypersensitivity to aspirin, iodides, or other NSAIDs; patients diagnosed with peptic ulcer disease, recent GI bleeding or perforation, renal insufficiency, and those at high risk of bleeding
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Not useful if vomiting is prominent feature, unless prior use of antiemetics makes PO administration tolerable; caution in patients with congestive heart failure, hypertension, and decreased renal and hepatic function
Beta-blockers
Effective in migraine prophylactic therapy, possibly by blocking vasodilators, decreasing platelet adhesiveness and aggregation, stabilizing membranes, and/or increasing the release of oxygen to tissues.
Propranolol (Inderal)
Taken long-term, beta-blockers are frequently effective in reducing number of episodes and severity of attacks; when administering this medication, start with lowest dose and increase gradually (usually at monthly intervals) to allow maximum effect of each dose level.
Adult
Pediatric
Starting dose: 10-20 mg PO bid; increase to as high as 60-80 mg bid if necessary
Aluminum salts, barbiturates, calcium salts, cholestyramine, NSAIDs, penicillins, and rifampin may decrease bioavailability and plasma levels of propranolol, possibly resulting in decreased pharmacologic effect; conversely, haloperidol, hydralazine, loop diuretics, and MAOIs may increase metoprolol levels and its toxicity or pharmacologic effects
Documented hypersensitivity; asthma that requires beta agonists, insulin-dependent diabetes mellitus, and depressed mood
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
If patient experiences depressed mood, withdraw or try switching to atenolol; do not suddenly withdraw beta-blockers; for migraine treatment, full beta blockade is neither necessary nor desirable; assess pulse before and after a standard period of exercise prior to treatment and at follow-up visits; while resting and exercise pulse rates will both decrease, relative proportion of increase should be preserved; full beta blockade (ie, inability to raise pulse in response to exercise) is poorly tolerated and is not usually necessary; it is tolerated particularly poorly in athletes; beta-adrenergic blockade also may diminish signs and symptoms of acute hypoglycemia; beta-adrenergic blockers may reduce clinical signs (eg, tachycardia) of hyperthyroidism
Tricyclic antidepressants
Low-dose tricyclic antidepressants (eg, amitriptyline, imipramine, nortriptyline) are useful in preventing migraines, particularly in cyclic vomiting syndrome.
Amitriptyline (Elavil)
Administered at a low dose, may be particularly effective in cyclic vomiting of childhood.
Adult
Pediatric
Start with lowest available dose
Young children: 5-10 mg PO qhs
Adolescents: 10-25 mg PO qhs; to avoid sedation, slowly titrate upwards
Maintenance dose: 20-50 PO mg/d PO; if ineffective and does not cause sedation, titrate to maximum 2-3 mg/kg/d PO divided bid or administer entire dose qhs
Avoid use with diphenhydramine and other anticholinergics and antihistamines; use with other anticholinergic agents may be additive, resulting in significant sedation, dry mouth, and confusion; phenobarbital may increase metabolism, decreasing its effects, blocking uptake of guanethidine, and preventing hypotensive effects; may interact with thyroid medications, alcohol, CNS depressants, barbiturates, and disulfiram
Documented hypersensitivity; in cardiac conduction disturbances, glaucoma, urinary retention history, and patients with seizures; do not administer to patients that have taken MAOIs in the past 14 d
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
If using higher doses of tricyclics, monitor ECG (for QTc) and blood levels for primary drug and metabolites; caution in patients with cardiac conduction disturbances, those with history of hyperthyroidism, and those with renal or hepatic impairment
Anticonvulsants
Valproic acid, topiramate, phenobarbital, and phenytoin usually have antimigraine activity in doses lower than those generally used for preventing seizures. Only divalproex sodium (Depakote) is approved specifically for migraine prophylaxis. Topiramate has been reported to reduce migraine attacks in adults but is not yet approved for migraine prophylaxis in children.
Divalproex sodium (Depakote)
A stable coordination compound, comprising sodium valproate and valproic acid in a 1:1 molar relationship; recently gained FDA approval for prevention of migraine; it is likely that all forms of valproic acid have similar efficacy; the following preparations can be used: 250 mg tablets, 125 mg sprinkle caps, or 250 mg/5 mL liquid (US preparations).
Adult
Pediatric
Starting dose: 5-10 mg/kg PO divided bid; the dose can be increased gradually, not to exceed 30-40 mg/kg divided bid
Substantial interactions occur with virtually all medications metabolized by p450 enzymes; primarily, these include other anticonvulsants, anticoagulants, and some antiretrovirals; because of potential thrombocytopenia and platelet antiaggregant effect, concurrent use of aspirin is a relative contraindication; small (but potentially significant) decrease in clearance and increase in half-life occur when taken concomitantly with cimetidine; erythromycin may increase serum concentrations, producing toxicity
Coadministration with felbamate may increase mean peak valproate levels by 35%; rifampin may increase oral clearance of valproate by 40%; in pediatric patients, protein binding and metabolism of valproate decrease when taken concomitantly with salicylates; when taken concurrently with valproate, variable changes in carbamazepine concentrations with increased levels of the active metabolite or decreased valproic acid levels with possible loss of seizure control may occur; displaces diazepam from its plasma albumin binding sites and inhibits its metabolism, increasing diazepam toxicity
Because it inhibits ethosuximide metabolism, monitor the serum levels of both drugs, especially in the presence of other anticonvulsants; inhibits phenobarbital metabolism, and phenobarbital can increase valproate clearance; increased action of phenytoin (even at therapeutic levels) or increased metabolism of valproic acid with decreased pharmacologic effects may occur; may displace warfarin from protein binding sites; monitor coagulation tests; zidovudine clearance may decrease in HIV-seropositive patients
Documented hypersensitivity; in hepatic disease or dysfunction or a history of thrombocytopenia from valproic acid
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Carefully monitor patients early in treatment; monitor periodically while patient is stable; adolescent girls may experience substantial weight gain and irregular menses; polycystic ovaries can develop; thrombocytopenic effect, particularly at higher doses and during intercurrent illnesses, may cause bruising and/or bleeding; mitochondrial syndromes may be worsened, thus, use with extreme caution; do not use in pregnant adolescents or sexually active adolescents who are not using adequate birth control
Topiramate (Topamax)
Migraine prophylaxis in adults is a labeled indication for use. Studies are underway in adolescents and children.
Is sedating and causes cognitive slowing if dose is advanced rapidly or starting dose is high.
Adult
Pediatric
Start with smallest available dose and gradually increase until effective or dose-limiting side effects occur; young children typically start on 15-mg "sprinkle" capsules once or twice a day, advance by one capsule per week, switching to 25-mg "sprinkle" capsules once dose is beyond 45 mg bid; older children who can swallow tablets begin with 25-mg tab; increase by 25 mg/wk as needed and tolerated
Phenytoin, carbamazepine, and valproic acid can significantly decrease topiramate levels; topiramate reduces digoxin and norethindrone levels, when administered concomitantly; concomitant use with carbonic-anhydrase inhibitors may increase risk of renal stone formation and should be avoided; use with extreme caution when administering concurrently with CNS depressants because may have an additive effect in CNS depression, as well as other cognitive or neuropsychiatric adverse events
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May promote renal stones formation, particularly in poor fluid intake; inform patients that adequate hydration is mandatory at all times; rare reports of oligohidrosis and heat stroke have occurred, as well as apparent induction of acute glaucoma; causes anorexia sufficient to provoke weight loss in up to 10% of children, particularly when medication is initiated; cognitive dulling and word finding problems are common when initiating, and slow titration is necessary to avoid cognitive adverse effects; sprinkle capsules should be swallowed whole or carefully open capsule and sprinkle contents on soft food immediately before ingestion, do not chew or crush
Calcium channel blockers
Migraine prophylaxis has been reported with various calcium channel blockers, including verapamil, nifedipine, and others. The calcium channel blocker with the highest evidence of efficacy is flunarizine, which is not available in the US. Results are not entirely predictable, and dosage must be individualized. Some patients experience exacerbation of migraine with these agents.
Verapamil (Calan, Calan SR, Covera-HS, Verelan)
Relaxes smooth muscles and increases oxygen delivery during vasospasms. Used in children for migraine with aura and basilar migraine. The drug has not been FDA-approved for use in migraine.
Adult
Pediatric
2-4 mg/kg/d PO divided bid/tid; increase gradually as tolerated, not to exceed 8 mg/kg/d
Alters metabolism of carbamazepine (increases serum levels); grapefruit juice and caffeine reduce clearance
Documented hypersensitivity; significant cardiac disease; hepatic or renal impairment
Pregnancy
Precautions
May worsen headaches in some patients
Metabolic support
Metabolic support to prevent catabolic state is indicated in migrainelike episodes caused by suspected mitochondrial cytopathies. IV glucose and occasionally carnitine supplementation may be useful.
IV fluids containing either 5% or 10% dextrose
Goal is to prevent dehydration and catabolic state in mitochondrial cytopathies.
Adult
Pediatric
Conventional volumes for fluid replacement and maintenance hydration, using fluids containing 5-10% dextrose
None reported
Monitor blood sugar level; avoid hyperglycemia if using D10
Pregnancy
A - Fetal risk not revealed in controlled studies in humans
Precautions
Monitor blood sugar level if using D10
Levocarnitine (Carnitor)
A vitaminlike substance that is necessary for transport of fatty acids into mitochondria; a cofactor in mitochondrial energy production. It can be deficient in organic acidurias and/or mitochondrial dysfunction and can be depleted with administration of valproic acid. Supplementation with L-carnitine may be helpful in mitochondrial cytopathies to prevent episodes of severe metabolic collapse and encephalopathy. Supplementation may be useful in cyclic vomiting or atypical migraine syndromes caused by mitochondrial dysfunction.
Adult
Pediatric
25-100 mg/kg/d long-term PO dosing; in acute metabolic encephalopathies caused by mitochondrial dysfunction, higher IV dosage may be used briefly, not to exceed 300 mg/kg/d
None reported
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Check serum-free and total carnitine level before beginning treatment and to monitor dosing; excess PO carnitine causes diarrhea and GI distress; administration causes change in urine and body odor ("fishy smell")
Antihistamines
Cyproheptadine occasionally is useful for migraine prophylaxis, probably because of its serotonergic, rather than antihistaminic, effects. Other antihistamines generally are not useful for migraine prophylaxis.
Cyproheptadine (Periactin)
An antihistamine that has been used for migraine prevention in children more than in adults. Usually well tolerated. Mechanism of action not clarified, and hypotheses include antihistaminic and anti-5-HT 2 effects.
Adult
Pediatric
2-4 mg PO tid; because of sedation, may need to start at lower dose
Sedatives tend to be potentiated; concurrent use of MAOI contraindicated
Concurrent use of MAOI; unacceptable sedation or weight gain generally limits usefulness
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Cyproheptadine is an appetite stimulant; inform patient and parent of need to control dietary intake; also sedating, particularly when first started
Water soluble vitamins
Riboflavin, with or without magnesium supplements, with or without herbals (feverfew), has been used to prophylax migraine headaches. Dosage ranges from 200-400 mg/d for adults. No pediatric dose is established. The only side effect is bright yellow-green discoloration of urine. Patients should be warned about this harmless effect so they are not alarmed.
Riboflavin (Riobi)
Essential in the activation of pyridoxine and conversion of tryptophan to niacin. Component of flavoprotein enzymes, which are necessary for tissue respiration.
Adult
400 mg PO qd
Pediatric
Not established
Probenecid decreases absorption
None reported
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Riboflavin deficiency often occurs in presence of other B vitamin deficiencies
Electrolyte supplements
Magnesium salts, typically magnesium oxide, are combined in a commercial OTC preparation for migraine prophylaxis (MigreLief). Excess dosing may produce diarrhea.
Magnesium oxide (MagOx)
Used in migraine prophylaxis.
Adult
300-400 mg PO qd
Pediatric
Not established
May decrease effects of benzodiazepines, chloroquine, corticosteroids, digoxin, H2 antagonists, hydantoins, nitrofurantoin, tetracyclines, iron salts, ticlopidine, phenothiazines, iron salts; increases the effects of dicoumarol, quinidine, and sulfonylureas
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Hypermagnesemia and toxicity may occur in renal impairment when >50 mEq magnesium is given qd due to decreased clearance of magnesium ion; approximately 5-20% of orally administered magnesium salts can be systemically absorbed
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
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
