MigraineMigraine is the second most common type of headache and a disabling brain disorder that consists of recurrent attacks of unilateral headaches that are often experienced in conjunction with nausea, phonophobia, and photophobia [1,2]. Prior to the headache, one may experience an aura, or transient neurological symptoms, most often visual. The cumulative lifetime incidence of migraine is 43% in women and 18% in men [3] and is the leading cause for individuals to seek medical attention at neurological facilities [1]. Prevalence estimates indicate that up to 10.6% of children ages 5 to 15 years and 28% of adolescents between the ages of 15 and 19 years suffer with migraines [4]. Despite its prevalence, migraine remains commonly undiagnosed or misdiagnosed, in both children and adults [5][6][7]. In children, frequent headaches can cause a significant impact on educational functioning [8], as well as quality of life, prompting the need for early recognition and treatment. The long-term outcome of childhood headaches and evolution into adult headaches remains largely unknown.The patho physiology of migraines is complex and is thought to be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway. Moreover, serotonin imbalance is thought to exacerbate and contribute to migraines. Stewart et al [3] suggests that the common occurrence of migraine may be linked to minor perturbations of normal brain function. Migraine pain begins with the activation of meningeal nociceptive trigeminal sensory afferents, which leads to are lease of vasoactive neuropeptides at their peripheral nerve terminals. Subsequently, there is an activation of second-order neurons in the trigeminal nucleus caudalis and then an activation of brain structures involved in the processing and perception of pain [2]. The process of maintaining the severe prolonged pain of migraine headache is attributed to the sensitization of meningeal nociceptors and sensitization of central neurons of the trigemino vascular system. There is a strong genetic component but causative genes have not been identified, except for familial hemiplegic migraine.
Hemiplegic migraineHemiplegic migraine (HM) is a rare form of migraine with transient hemiplegia during the aura phase characterized by
AbstractThe clinical interview is an important part of a pediatric neuropsychological evaluation. Investigating the history of symptoms, the family, and genetic factors can often clarify etiological information. This manuscript will review a case of a 12 year old girl (HA) who has a family history of migraine headaches, but had previously been diagnosed and treated as a child with multiple mild grade 1 concussions. These suspected concussions were purportedly resulting in infrequent, but intermittent hemiplegic migraines. Specifically, HA suffered Hemiplegic Migraines which involved right dominant hand hemiplegia and significantly altered level of consciousness for approximately 12-24 hours, resulting in a full return to physical and co...