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Howell DM, Lamouree G. Acute Confusional Migraines: A Case Report. Clin Pract Cases Emerg Med 2024; 8:206-210. [PMID: 39158232 PMCID: PMC11326068 DOI: 10.5811/cpcem.4918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/17/2024] [Accepted: 01/26/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Acute confusional migraine (ACM) is a rare variant of migraine that is benign and self-resolving but difficult to diagnose. Without known causative pathophysiology and a lack of recognition in the International Classification of Headache Disorders (ICHD-3), ACM offers a puzzling clinical presentation. There currently is no standardized treatment for ACM, but with a growing anecdotal dataset there is the opportunity to formally recognize and establish protocols to improve patient care and outcomes. Case Report A 14-year-old female presented to the emergency department (ED) with acute onset of confusion, vision changes, right-sided weakness, and dysarthria one hour prior to arrival. A stroke workup at the initial ED offered no pertinent findings. The patient was transferred to a pediatric specialty ED where all symptoms, aside from numbness and a mild headache, resolved during transfer. After administration of a migraine cocktail at the pediatric specialty ED, all remaining symptoms completely resolved. The patient was discharged home from the ED the same evening with outpatient follow-up. Conclusion This case presents the difficulty of diagnosing and treating ACM prior to its self-resolution. It highlights the need for formal recognition of the condition by the ICHD-3. In doing so, greater recognition will promote more research, awareness, and establishment of a standardized treatment for ACM.
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Affiliation(s)
- Devin M. Howell
- Northwell Health, Department of Emergency Medicine, Huntington, New York
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Molina Gutiérrez MÁ, Ventas Maestre R, Rodríguez Sánchez C, Díaz de Terán J. Clinical characterization of pediatric acute confusional migraine: a single-center case series. Acta Neurol Belg 2024:10.1007/s13760-024-02582-1. [PMID: 38755330 DOI: 10.1007/s13760-024-02582-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Acute confusional migraine (ACM) is a rare disorder characteristic of pediatric patients. Our objective was to describe the clinical characteristics of patients diagnosed with ACM who visited our pediatric emergency department (PED). METHODS This study was a retrospective review of children who presented to our PED between January 2012 and December 2022 with a discharge diagnosis of ACM. RESULTS During the study period, 23 patients were enrolled: 11 males (47.8%) and 12 females (52.2%); median age was 10.8 years (IQR: 8.3-13.6). Eight patients reported a history of headache. The median length of stay of PED was 4.7 h. Onset was abrupt (less than 12 h) in 100% of cases. Changes in the level and content of consciousness occurred in 47.8% and 91.3% of patients, respectively; confusion (73.9%) was the most common neurological manifestation. Eighteen patients had urgent brain CT scans, none showing pathological findings. Four patients required benzodiazepines to control their psychomotor agitation. Nine patients were hospitalized, including one in the intensive care unit. Two patients underwent MRI and one patient underwent EEG during hospitalization, with normal results. DISCUSSION ACM is a rare condition in pediatric neurology characterized by acute onset of confusion or altered mental status before, during, or after migraine headache. Clinical features overlap with other neurological disorders, making diagnosis challenging. To improve the diagnosis, treatment, and research of AMC, it is essential to include it in the International Classification of Headache Disorders and establish standardized diagnostic criteria.
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Affiliation(s)
| | - Raquel Ventas Maestre
- Pediatric Emergency Department, Hospital Universitario la Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - César Rodríguez Sánchez
- Pediatric Department, Hospital Universitario del Vinalopó, Carrer Tonico Sansano Mora, 14, 03293, Elx, Alicante, Spain
| | - Javier Díaz de Terán
- Headache Unit, Department of Neurology, Hospital Universitario de la Paz, Madrid, Spain
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Evans RW. The Postconcussion Syndrome and Posttraumatic Headaches in Civilians, Soldiers, and Athletes. Neurol Clin 2024; 42:341-373. [PMID: 38575256 DOI: 10.1016/j.ncl.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Posttraumatic headaches are one of the most common and controversial secondary headache types. After a mild traumatic brain, an estimated 11% to 82% of people develop a postconcussion syndrome, which has been controversial for more than 160 years. Headache is estimated as present in 30% to 90% of patients after a mild head injury. Most headaches are tension-type-like or migraine-like. Headaches in civilians, soldiers, athletes, and postcraniotomy are reviewed. The treatments are the same as for the primary headaches. Persistent posttraumatic headaches can continue for many years.
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Affiliation(s)
- Randolph W Evans
- Neurology, Baylor College of Medicine, 1200 Binz #1370, Houston, TX 77004, USA.
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Evers S, Tassorelli C. Migraine with aura. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:169-186. [PMID: 38043960 DOI: 10.1016/b978-0-12-823356-6.00009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
This chapter describes the different types of aura including rare aura subtypes such as retinal aura. In addition, aura manifestations not classified in the International Classification of Headache Disorders and auras in headache disorders others than migraine are also described. The differential diagnosis of migraine aura comprises several neurological disorders which should be known to specialists. Migraine aura also has impact on the choice of migraine treatment; recommendations for the treatment of the migraine aura itself are also presented in this chapter.
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Affiliation(s)
- Stefan Evers
- Faculty of Medicine, University of Münster, Münster, Germany; Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany.
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Ferrante E, Trimboli M, Erminio C, Martino I, Tiraboschi P. Acute confusional migraine in CADASIL: A case report and literature review. Clin Neurol Neurosurg 2022; 216:107239. [PMID: 35413636 DOI: 10.1016/j.clineuro.2022.107239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Acute confusional state associated with migraine in adults is an infrequent entity. Around 30-60% of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) patients get affected by migraine attacks-the majority with aura-often as the first symptom of the disease. Acute confusional state during migraine has been rarely described in CADASIL patients and a complete neuropsychological assessment during the acute phase has never been conducted so far. CASE SUMMARY We here describe the clinical and neuropsychological features of two distinct episodes of ACM in a 54-year-old female with CADASIL. EEG recording during acute confusional migraine and after attack resolution and neuroimaging has been reported. DISCUSSION AND LITERATURE REVIEW This paper also reports a literature review on the topic of ACM in CADASIL highlighting a lack of adequate knowledge about this entity among clinicians and prompting further larger studies to explore its incidence and characteristics.
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Affiliation(s)
- Enrico Ferrante
- Department of Neurology, Alto Vicentino Hospital - AULSS 7 Pedemontana, Santorso (IT), Italy; Department of Neurology, AOR San Carlo, Potenza, Italy; Department of Neuroradiology, Niguarda Ca Granda Hospital-Milan (IT), Italy.
| | - Michele Trimboli
- Department of Neurology, AOR San Carlo, Potenza, Italy; Institute of Neurology, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro (IT), Italy.
| | - Cristina Erminio
- Department of Neuroradiology, Niguarda Ca Granda Hospital-Milan (IT), Italy
| | - Iolanda Martino
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro (IT), Italy
| | - Pietro Tiraboschi
- Division of Neurology, Scientific Institute for Research, Hospitalization, and Care (IRCCS) Foundation "Carlo Besta" Neurological Institute, Milan, Italy
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Dasgupta S, Vanspauwen R, Guneri EA, Mandala M. Vincent Van Gogh and the elusive diagnosis of vestibular migraine. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2021.110747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Acute Confusional Migraine: Unusual Great Masquerader-Case Report and Literature Review. Case Rep Neurol Med 2020; 2020:9604924. [PMID: 33163241 PMCID: PMC7605926 DOI: 10.1155/2020/9604924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 09/18/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background. Acute confusional migraine (ACM) is a rare variant of migraine, mainly prevalent in children and adolescents. It is not currently indexed as a distinct variant of migraine likely since only a few cases were reported in the adult population. We report a case of delayed ACM diagnosis in a young man and present a concise-related literature review. Case Presentation. A thirty-eight-year-old man with a past medical history of migraine, not on any treatment, presented with headaches accompanied by confusion. Over a two-year period before the current presentation, he experienced two episodes of confusion, which required hospital admission for evaluation: once mislabeled as a psychiatric illness and diagnosed as a migrainous infarct in the second hospitalization. In the current presentation, he reported a similar history of headache accompanied by confusion. The examination was remarkable for disorientation; otherwise, no focal deficit was elicited. Laboratory testing, cerebrospinal fluid, and neurological imaging were all unremarkable. His symptoms improved spontaneously within less than twenty-four hours, similar to his previous presentations. After two-year history of episodic confusion and after excluding other plausible causes of confusion, guided by proposed diagnostic criteria, we diagnosed him as a case of ACM. The patient remains well at the follow-up of two months after discharge. Discussion and Conclusion. ACM is a rare variant of migraine and is often a challenge for clinicians to diagnose appropriately. Until recent years, the disease was thought to be limited to children and adolescents. However, recently few reports also expanded the incidence of this entity to the adult population. There is a significant gap in knowledge about proper identification and treatment of this condition, leading to delayed or overlooked ACM diagnosis. Moreover, the recent edition of the International Classification of Headache Disorders (ICHD-3) does not account for this entity, thereby further adding to physicians' lack of awareness regarding this migraine subtype. The authors emphasize that clinicians be aware of this entity and adequately utilize the existing proposed diagnostic criteria for ACM until standardized and validated tools are available. We also believe that this entity should be acknowledged in the subsequent migraine guidelines and classifications.
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Factors Affecting Vision and Visio-Spatial Intelligence (VSI) in Sport: A Review of the Literature. Asian J Sports Med 2020. [DOI: 10.5812/asjsm.101670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
: Sport has become increasingly competitive, prompting the need to determine, as far as possible, any likely performance advantage. While the focus of athletic research, testing, and training is on the physiological and physical characteristics of the sport, visual abilities not only affect sport performance directly, but also affect the acquisition of motor skills. Vision, and visual-spatial intelligence (VSI), are a relatively new and underexplored area of athletic performance. As with physiological and physical parameters, a range of factors affect vision and VSI in sporting activities. This review of the literature is a first attempt to summarize and compile an overview of the factors affecting vision and VSI in athletes, covering those previously connected with sport, as well as those hitherto not associated with athletic activities, but that could also play a part in sports performance. The evidence from this review suggests that while current research still tends to focus on single factors affecting vision and VSI, a large number of such factors have been identified that could affect vision and VSI. This offers new opportunities for researchers to investigate the effects of a combination of factors, and for conditioning and/or sports vision specialists to explore further possibilities for competitive advantage.
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Kano Y, Oguri T, Sugiyama H, Kikui S, Takeshima T, Yuasa H. [Confusional migraine in a young adult female: Is it a subtype of migraine with aura?]. Rinsho Shinkeigaku 2020; 60:46-50. [PMID: 31852872 DOI: 10.5692/clinicalneurol.cn-001337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A 22-year-old female was admitted to our hospital due to acute onset of severe headache, confusion, and deterioration of consciousness. Results of initial examinations did not suggest cerebrovascular diseases, encephalitis, or nonconvulsive status epilepticus. Over the next several weeks, her level of consciousness fluctuated in parallel with the severity of headache. The electroencephalogram, recorded during a symptomatic episode, showed lack of posterior dominant rhythm, and the single-photon emission CT (SPECT) also revealed a decrease in cerebral blood flow predominantly in the occipital lobes. Administration of sodium valproate and topiramate, recommended as treatment for migraine, dramatically ameliorated her headache and consciousness. Although this was an adult-onset case, her symptoms and clinical course were similar with the diagnosis of ICHD-3-unlisted confusional migraine rather than other listed subtypes of migraine with aura. Further accumulation of similar adult-onset cases is necessary to clarify the nature of this illness.
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Affiliation(s)
- Yuya Kano
- Department of Neurology, Tosei General Hospital
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