Migraine Headaches

Q. My son has been having some strange episodes that include the following: stuttering, not knowing common words that he should, for getting where things are when he has been around them most of his life, wrists turning in, falling to one side, strange smells, feeling like he is in the clouds, recently urinating the bed at nights, and eye fluttering.

Some docs say it could be migrains and some are saying it could be some sort of seizure. His first EEG came back normal. He had a second one done and we are waiting for the results. He goes in tomorrow for a MRI and has had a CT and it came back normal.

My question is: can this be caused from a migraine? He has not complained about a headache. He just wants to go to sleep after these episodes happen. I'm confused about what to do. I do have epilepsy on my side of the family and he has had febrile seizures in the past. Helen, Mishawaka, IN

A. It is possible that those episodes are being caused by his having a migraine, especially if migraines run in the family and he is totally well in between episodes. But those are complicated symptoms that require a thorough evaluation by a Pediatric specialist, like a Child Neurologist, for a diagnosis.

Although you usually think of the classic symptoms of a migraine as including an aura, nausea, vomiting, and a pounding or throbbing headache, there are other types of migraines, including:

Complicated Migraines

• Basilar Migraine - which according to the Nelson Textbook of Pediatrics has major symptoms of 'vertigo, tinnitus, diplopia, blurred vision, scotoma, ataxia, and an occipital headache'
• Ophthalmoplegic Migraine - with a third-nerve palsy with ptosis or eyelid drooping
• Hemiplegic Migraine - with one sided numbness and weakness of a child's arms, legs, or face, and aphasia, or not being able to talk on understand when other people are talking

Migraine Variants

• Cyclic Vomiting - recurrent episodes of vomiting that can lead to children becoming dehydrated
• Acute Confusional States - this type of 'migraine may present in a bizarre fashion, particularly in children, characterized by confusion, hyperactivity, disorientation, unresponsiveness, memory disturbances, vomiting, and lethargy.'^*
• Benign Paroxysmal Vertigo - attacks of nausea, vomiting, and ataxia, 'causing the child to fall or refuse to walk or sit'^*

So it is possible that your child's episodes are being caused by the Acute Confusional State form of migraine variant, since that seems to include many of his symptoms.

It is good that he is undergoing additional testing, such as the CT, MRI, and EEG, to make sure it isn't something else though, including:

• drug use
• epilepsy
• other neurological diseases
• a psychiatric condition

A video EEG or continuous EEG may also be a good idea to see what the EEG looks like during an episode.

^*source of quotes is the 16th Edition of the Nelson Textbook of Pediatrics