Acute confusional migraine in a teenager: a rare entity

*Correspondence: [e-mail].

Abstract

Case Presentation: JLL, male, 12-year-old, caucasian, with a presumed diagnosis of Attention-Deficit/Hyperactivity Disorder admitted on the emergency room of a tertiary hospital presenting severe and pulsating left hemicranial headache associated with nausea and two vomiting episodes. Two hours after onset of the pain, he acutely developed mental confusion, temporal and spatial disorientation and psychomotor agitation. Five hours later, these symptoms resolved spontaneously. We administered only analgesics and antiemetics to improve headache. Neurological examination was normal, before and after the attack. Complementary investigation including routine laboratory exams, magnetic resonance imaging of the brain and prolonged electroencephalogram had no alterations. Previously, four months ago, the patient had the same episode. At that time, it was attributed to the use of lisdexamfetamine and the medication was discontinued. Now, our diagnosis was Acute Confusional Migraine and because he had only two crises so far, we decided to adopt just an abortive treatment, without prophylaxis for migraine.

Discussion: The prevalence of migraine is high, including in pediatric population (11% in childhood and 23% in teenagers). However, Acute Confusional Migraine is a rare variant, most common in this age group, especially on males with a proportion of three boys for one girl. At 80% of the cases, headache occurs previous or after the acute confusional state. The duration of the cognitive symptoms range from two to 24 hours and rate of recurrence is estimated in 33%. Considering the association of headache and alteration of consciousness level, the diagnostic is by exclusion, therefore, complementary investigation to exclude structural lesions, infections, metabolic disturbances, seizures, medications poisoning or drug abuse is essential. According to the literature, we report here a male teenager with two episodes of cognitive symptoms started after the headache, with normal investigation and resolution within 24 hours.

Final Comments: Acute Confusional Migraine is one uncommon and poorly understood condition. Our purpose is to disseminate knowledge of this entity, which should be considered in patients with this presentation and normal investigation, especially in pediatric group.

Publication History

Article published online:
12 May 2025