Acute confusional migraine: a variant not to be missed

Abstract

A middle age woman who had frequent migraines was admitted with memory loss following severe unilateral headache, restlessness and confusion. Investigations including haematology, biochemistry, cerebrospinal fluid analysis serology and imaging were normal. As she had frequent migraines with a history of ophthalmoplegic migraine, acute confusional migraine was thought of as a possibility. The patient responded dramatically to intravenous sodium valproate. We report this case to emphasise that acute confusional migraine, a rare variant of migraine, is occasionally encountered in adults and prompt recognition will lead to appropriate management.

Acute Confusional Migraine: Distinct Clinical Entity or Spectrum of Migraine Biology?

“…About three fourth of these cases were seen in the children and adolescents (5–17 years) as shown in Figure 2 . Only a few case series included patients who were older than 18 years old [ 6 , 20 , 23 , 27 , 29 ]. A slight male predominance (57%) is evident among all of the reported cases (68 males/52 females).…”

“…Migraine specific treatments such as triptans and ergotamine or nonspecific treatments such as dopaminergic antagonist [ 21 ] and over-the-counter pain medications were often used. Common preventive medications such as anti-hypertensive (propranolol) [ 10 , 28 ], and anti-seizure (topiramate, valproic acid) [ 11 , 19 , 22 , 24 , 27 ] were used. These medications might be effective in the prophylaxis of ACM due to inherent ability to affect CSD [ 59 ] as well as modulate altered neurotransmission of the trigeminovascular pathway [ 60 , 61 ].…”

“…We made an effort to define this reversible altered mental status in detail. The age limit cannot be specified in the criteria as a few of these cases, i.e., approximately 17%, are reported in the adult population apart from children and early adolescents [ 6 , 20 , 23 , 27 , 29 ]. Moreover, the reference to pediatric syndromes may result in missed diagnoses especially in the elderly population [ 31 ].…”