Objective:
To present and analyze four cases in young children where migraine onset occurred after subconcussive head impact and to review what is known about the clinical presentation, environmental, and genetic risk of these two diagnoses.
Background:
Migraines and concussions often present with similar symptoms such as headache, nausea, photophobia, and cognitive impairment, making accurate diagnosis challenging, particularly in the acute setting. The pathophysiology for the activation of the trigeminovascular complex causing migraine and neurological symptoms due injuries to the head and neck accounts for symptom overlap (figure 1). Clues to the correct clinical diagnosis depend family history, alleviating factors, the mechanism of injury, symptom profile, and time course of symptoms to meet the criteria for concussion diagnosis.
Design/Methods:
This retrospective chart review describes four pediatric patients who presented to the emergency room following head or face impact. Literature review was conducted on PubMed using key search phrases including pediatric migraine, pre-pubertal migraine, and imitators of concussion.
Results:
Patient comparisons are presented in Table 1. All patients were female, premenarche, had a family history of migraine, and presented following a traumatic head injury. Each patient had a history of cyclical vomiting or carsickness. Key mediating factors in patient symptoms included pain relief after vomiting and lessening headaches after menarche. All patients met the criteria for acute migraine per the International Classification of Headache Disorders (ICHD3) criteria. None of the patients met the criteria for diagnosis of concussion based on the 2014 criteria [3] or 2023 consensus[4] statement on concussion in sport.
Conclusions:
Differentiating migraine from concussion requires a thorough understanding of the pathophysiology, clinical presentation, diagnostic criteria, and management for both conditions. By employing a comprehensive approach to evaluation and management, healthcare providers can optimize patient care, mitigate potential complications, and improve outcomes for individuals presenting with headache-related symptoms following head trauma or other triggers.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.