Migraine Equivalents
Several discrete migraine syndromes without prominent headache have been recognized in children and adolescents. These migraine equivalents are also termed migraine precursors, periodic syndromes of childhood, or specific migraine subsets. They are related to migraines by their periodicity, paroxysmal nature, frequent evolution to more common migraine variants, similarity to recognized adult migrainous syndromes, and the likelihood of a positive family history for migraines.
Since there are no definitive tests or biologic markers, diagnosis of these pediatric migraine equivalents requires recognition of discrete syndrome complexes, together with negative test results for other conditions with similar symptoms.
Four examples of migraine equivalents are:
1.) Benign paroxysmal vertigo Onset 1-3 years of age Vertigo, unsteadiness, pallor, and fear Typically lasts 1-5 minutes Resolves 1-2 years after onset
2.) Acephalgic migraine Onset 5-12 years of age Visual auras, typically with distorted visual images (Alice in Wonderland syndrome) Lasts <10 minutes Child often has migrainous vascular headaches as well
3.) Acute confusional migraine Onset 5-15 years of age Minor head trauma often precedes event Confusion, agitation, and memory disturbances Headache a minor component Lasts 6-8 hours Rarely recurs
4.) Abdominal migraines Onset 4-10 years Crampy, periumbilical abdominal pain (may have nausea and vomiting) Typically lasts 30-60 minutes Resolves 1-2 years after onset Tend to develop typical migraine in later life
Migraine equivalents are age-dependent, developmentally determined expressions of an individualšs tendency toward migraine. They probably are underdiagnosed. Knowing the signs and symptoms of these conditions helps rule out more serious illnesses.
(Shevell M. A guide to migraine equivalents. Contemporary Pediatrics 1998; 15(6):71-79)
COMMENT: At one time "migraine equivalent" was a wastebasket diagnosis for almost any unexplained phenomenon. The first to gain some credibility was abdominal migraine. These syndromes remain vague and difficult to diagnose and treat, even for neurologists.