Childhood Migraine Variants Differential Diagnoses

Updated: Nov 19, 2019
  • Author: Wendy G Mitchell, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA  more...
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Diagnostic Considerations

The diagnosis of migraine and migraine variants is a clinical one that is 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, or hydrocephalus) would likely be viewed as a breach in the standard of care.

When the patient is symptomatic and has an abnormal neurologic examination, migraine variant can almost never be diagnosed unless there is a consistent pattern 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 until other serious pathologic conditions have been carefully ruled out.

In addition to the conditions listed in the differential diagnosis (see below), other problems to be considered include the following:

  • Alternating hemiplegia of childhood

  • Benign occipital epilepsy of childhood

  • Cerebral autosomal dominant arteriopathy and subcortical infarcts and leukoencephalopathy (CADASIL), [19] for alternating hemiplegias presenting in adolescents

  • Complex partial status epilepticus

  • Ingestions

  • Intoxications

  • Organic acidurias

  • Somatoform disorder

Differential Diagnoses