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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Feb 8, 2015; 4(1): 1-12
Published online Feb 8, 2015. doi: 10.5409/wjcp.v4.i1.1
Spectrum of complicated migraine in children: A common profile in aid to clinical diagnosis
Surya N Gupta, Vikash S Gupta, Dawn M Fields
Surya N Gupta, Dawn M Fields, Pediatric Neurology, CAMC, Charleston, WV 25301, United States
Surya N Gupta, Section Child Neurology, Women’s and Children’s Hospital, Charleston Area Medical Center, Charleston, WV 25301, United States
Vikash S Gupta, Texila American University, Georgetown 05924, Guyana
Author contributions: Gupta VS searched and prepared initial version of the draft; Fields DM provided the clinical information regarding individual syndromes of complicated migraine; Gupta SN initiated, supervised, coordinated, proposed the common profile, and contributed in discussion of complicated migraine; all the authors approved the final version of this manuscript.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Surya N Gupta, MD, Associate Professor, Pediatric Neurology, CAMC, 415 Morris Street, Suite 300, Charleston, WV 25301, United States. suryangupta@rediffmail.com
Telephone: +1-304-3886441 Fax: +1-304-3886445
Received: November 4, 2014
Peer-review started: November 4, 2014
First decision: November 21, 2014
Revised: December 6, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: February 8, 2015
Abstract

Complicated migraine encompasses several individual clinical syndromes of migraine. Such a syndrome in children frequently presents with various neurological symptoms in the Emergency Department. An acute presentation in the absence of headache presents a diagnostic challenge. A delay in diagnosis and treatment may have medicolegal implication. To date, there are no reports of a common clinical profile proposed in making a clinical diagnosis for the complicated migraine. In this clinical review, we propose and describe: (1) A common clinical profile in aid to clinical diagnosis for spectrum of complicated migraine; (2) How it can be used in differentiating complicated migraine from migraine without aura, migraine with aura, and seizure; (3) We discuss the status of complicated migraine in the International Headache Society classification 2013; and (4) In addition, a common treatment strategy for the spectrum of migraine has been described. To diagnose complicated migraine clinically, it is imperative to adhere with the proposed profile. This will optimize the use of investigation and will also avoid a legal implication of delay in their management. The proposed common clinical profile is incongruent with the International Headache Society 2013. Future classification should minimize the dissociation from clinically encountered syndromes and coin a single word to address collectively this subtype of migraine with an acute presentation of a common clinical profile.

Keywords: Electroencephalography, Seizure, Seizure like activity, Complicated migraine, Stroke, Magnetic resonance imaging

Core tip: Complicated migraine in pediatric neurology practice is a frequent cause for an Emergency Department visit. Their clinical presentations are variable. They mimic several clinical syndromes but they can be diagnosed clinically by following proposed common clinical profile closely in the absence of any identifiable etiology.