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

Table 4 Lists the diffrential diagnosis of migraine like syndromes, their presenting symptoms, and the confirmatory laboratory tests

Migraine like syndrome	Presenting symptom	Confirmed by
Aseptic meningitis	Infants and children age < 5 yr presenting with constitutional symptoms together with meningeal signs	Cerebrospinal fluid study molecular testing by polymerase chain reaction[28]
Pseudotumor cerebri	Persistent headache with prominent visual symptoms and head tilt	An increased intracranial opening pressure measured in calm patient with straight leg position
Subarachnoid hemorrhage	Waxing and waning levels of consciousness, apnea, bradycardia before seizure	Brain computerized tomography and/or presence of blood or xanthochromic cerebrospinal fluid
Sinus venous thrombosis	Altered mentation with no obvious etiology or no seizures	Brain computerized tomography with and without contrast or MRV
Arteriovenous malformation	Sensory cutaneous aura with or without seizure or headache	MRA and MRV or computerized tomographic angiography
MELAS	Early symptoms, muscle weakness and pain, recurrent headaches, loss of appetite, vomiting, and seizures	MRI of the brain mimicking acute migrainous stroke but differs by having no respect to a specific cerebral arterial vascular territory
Brain tumor	Progressively worsening headache with onset of focal neurologic sign or seizure	Computerized tomography with contrast or MRI of the brain with and without contrast

The headache recurrent or persistent may be the presenting sign of migraine like syndromes except sinus venous thrombosis and subarachnoid hemorrhage. Their initial presentation is waxing and waning level of consciousness. MRV: Magnetic resonance venography; MRA: Magnetic resonance angiography; MELAS: Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes; MRI: Magnetic resonance imaging.