Spectrum of complicated migraine in children: A common profile in aid to clinical diagnosis

Table 3 Lists the common clinical characteristics of complicated migraine

	Clinical characteristics
Presenting feature	Any neurologic sign or symptom other than headache
Age	Commonly, but not limited to, occurs during infancy and childhood
Sex	Boys dominate in migraine variants and girls dominate in the rest of the complicated migraine other than migraine variants
Onset	Acute or sudden but relatively slower than seizure
The context	Patients may have past episode of similar or different symptomatology suggesting migraine attack
Modifying factor	Unlike migraine, none
Family history	Unlike common migraine, in complicated migraine a family history of migraine is almost always present
Course	Transient, may occur once in lifetime or may become episodic but always reversible with the exception to alternating hemiplegia
Examination	With few exceptions, particularly between the episodes, neurologic examination is almost always normal
Differential diagnosis: common/rare	Partial seizures, seizure like activity, transient ischemic attack/migraine like syndrome1 and acute stroke
Investigation	Usually normal including neuroimaging and electroencephalography
Diagnosis	A short course of the presenting symptom between seizure and common migraine defines the complicated migraine

¹Migraine like syndrome includes aseptic meningitis, pseudotumor cerebri, subarachnoid hemorrhage, sinus venous thrombosis, arteriovenous malformation, mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes, and rarely brain tumor. Complicated migraine is not a single entity. It includes a variety of individual clinical syndromes. The propose common clinical profile in add to clinical diagnosis of complicated migraine is quite distinct from other conditions like migraine with and without aura, seizure, and migraine like syndromes. To represent collectively such a large subgroup of the individual syndromes, the term complicated migraine has been used in this review.