You’ve had migraines before, and you suspect your 12-year-old son has them, too. One evening, he comes running into the room holding his head and crying. He tries to speak, but nothing understandable comes out. Your first thought: My son is having a stroke! You call 911. Paramedics arrive and drive your child to the emergency room. But a CT scan reveals nothing abnormal. It’s the kind of event that can make you panic and leave you reeling.
Headache among children is not uncommon. In fact, anywhere from 37 to 51 percent of elementary age children experience headache. Migraines are the recurring headache most frequently reported among the pediatric population, affecting 1 in 10 children. But some migraines are far from common and need to be addressed immediately.
Five Obscure Childhood Migraines
The following obscure migraines represent some of the frightening headache disorders that could arise among children and adolescents.
1. Confusional Migraine
Strange symptom: inability to communicate
The scenario described in the introduction could occur in a child with confusional migraine. First noted in 1970 in the journal Pediatrics, confusional migraine involves a headache associated with disorientation and an inability to communicate, often the result of a minor head injury. The condition, typically seen in pre-teens and early teenagers (more often boys than girls), results in confusion and even combative behavior.
Interestingly, confusional migraine may come with no headache at all. And while it may last up to several hours, it usually resolves spontaneously, never to appear again.
2. “Alice in Wonderland” Syndrome
Strange symptom: visual distortion of bodily image
Although migraine is relatively common among children, migraine with aura, which includes a warning sign such as a visual hallucination prior to a migraine attack, is less common among children. Even rarer, though particularly disturbing, is a type of migraine with aura known as “Alice in Wonderland” syndrome.
“Alice in Wonderland” is a visual spatial disturbance involving a child or teen’s body image. They may see their bodies in a distorted shape or size—similar to what has been described in Lewis Carroll’s Alice in Wonderland. It is thought that Carroll himself may have suffered from these types of migraines. In one case, described in a 1979 issue of the journal Pediatrics, an 11-year-old girl describes her arms feeling like twigs or her hands feeling small. Stranger than fiction, indeed, and the type of thing that can really frighten a child.
3. Hemiplegic Migraine
Strange symptom: temporary paralysis
Like “Alice in Wonderland” syndrome, hemiplegic migraine, is also a type of migraine with aura and can be divided into two types: the kind that is passed down through generations of a family and the sporadic type that develop with no family history. Though it generally runs a limited course, hemiplegic migraine involves one of the most frightening forms of aura: The child may suddenly develop a one-sided weakness or even paralysis in as little as the face or as much as an entire side of the body.
Following the aura, up to an hour later, a headache typically develops and can occur on either side of the body. Perhaps most frightening, the weakness may persist even after the headache is treated.
4. Basilar Migraine
Strange symptom: appearing intoxicated
A third form of migraine with aura is basilar migraine. In this case, instead of an aura that involves a distorted body image, the aura involves episodes of severe dizziness, double vision and difficulty with balance and walking lasting up to about an hour. Children as young as seven can have this condition. They may describe their pain as “behind the eyes,” appear intoxicated or even pass out.
5. Cyclic Vomiting/Abdominal Migraine
Strange symptom: bouts of vomiting
These two conditions are often considered together, as both tend to occur more often among families where there is a history of migraine and both involve the gastrointestinal tract. Cyclic vomiting, which typically occurs in younger children with an average age of six, involves recurrent episodes of repeated vomiting, at least five times per hour. Between bouts of vomiting, children may report feeling fine but they may be dehydrated. Migraine is not typically part of cyclic vomiting; however, most of these children develop migraines when they get older.
Children with abdominal migraine tend to be a bit older than those with cyclic vomiting. They experience intermittent attacks of vague stomachaches that are not associated with either diarrhea or constipation. Research from the March 2011 issue of the journal Headache suggests that four to 15 percent of children referred to a specialist for abdominal pain have abdominal migraine.
These Childhood Migraines Require Emergency Consult
Any childhood headache that is recurrent, worsening or interfering with the child’s activities should be checked out. But if your child experiences any of the stranger symptoms described above, a trip to the emergency room is mandatory to rule out more serious conditions. The emergency room physician will want to gather all relevant information to ensure that symptoms like dizziness and weakness are not a sign of something worse like stroke, brain tumor, ulcerative colitis, drug ingestions, severe hydration, meningitis, etc. Your child may need blood work, a CT scan or an MRI to rule out the more serious conditions.
Once a proper diagnosis is made, it’s important to consult with a headache specialist to develop a treatment plan that the family and child can work through together. Treatment for these rare migraine disorders is the same as treatment offered to children with other types of migraines. This might include ice packs, magnesium, NSAIDs, abortive medications and anti-convulsants in IV form.
It should be noted that, while it’s less likely, adults can also experience these conditions. In these cases, it is even more important for an adult to see a physician for a diagnosis, as it is more likely in the adult population that these symptoms are a sign of something more serious, like a stroke.
How Common Are These Childhood Migraines?
- Headache: 37-51% of all children
- Migraine: 3.5-10% of all children
- Basilar migraine: 3-19% of children with migraine
- Cyclic vomiting: 0.0004-0.02% of all children
- Abdominal migraine: 20% of children with migraine
Hemiplegic migraine and “Alice in Wonderland” syndrome are so rare among children that incidence has not been widely documented.
These Precursors to Headache Require Emergency Attention
These two precursors to headache occur in the pediatric population and also require emergency medical attention:
Benign paroxysmal torticollis: It’s not uncommon to see a baby move his head to the side—but if he can’t move it back into position, the baby may be experiencing the twist and stiffness of torticollis. These recurrent episodes of head tilt to one side among infants may be accompanied by vomiting. So a trip to the physician is important to rule out gastrointestinal reflux. Usually these babies are born into families where there is a previous history of migraine, and research suggests there may be a specific gene associated with the disorder. But the condition is still so rare that only 103 cases have been noted in literature.
Benign paroxysmal vertigo: This disorder, which occurs in younger children ages two to five, involves sudden episodes of loss of balance, usually accompanied by vomiting and pallor. After sleep, their balance returns to normal. Research published in the March 2011 issue of the journal Cephalalgia found that attacks ended around the median age of six years, though there was wide variation. And a majority of the children reported having recurrent headaches even after the vertigo resolved.
