children, migraine with aura, which includes a warning sign such as a visual hallucination prior to a migraine attack, is less common among children. Even rarer, though particularly disturbing, is a type of migraine with aura known as“ Alice in Wonderland” syndrome.
“ Alice in Wonderland” is a visual spatial disturbance involving a child or teen’ s body image. They may see their bodies in a distorted shape or size— similar to what has been described in Lewis Carroll’ s Alice in Wonderland. It is thought that Carroll himself may have suffered from these types of migraines. In one case, described in a 1979 issue of the journal Pediatrics, an 11-year-old girl describes her arms feeling like twigs or her hands feeling small. Stranger than fiction, indeed, and the type of thing that can really frighten a child.
3. HEMIPLEGIC MIGRAINE
Strange symptom: temporary paralysis Like“ Alice in Wonderland” syndrome, hemiplegic migraine, is also a type of migraine with aura and can be divided into two types: the kind that is passed down through generations of a family and the sporadic type that develop with no family history. Though it generally runs a limited course, hemiplegic migraine involves one of the most frightening forms of aura: The child may suddenly develop a one-sided weakness or even paralysis in as little as the face or as much as an entire side of the body.
Following the aura, up to an hour later, a headache
Two More to Watch for
These two precursors to headache occur in the pediatric population and also require emergency medical attention:
Benign paroxysmal torticollis: It’ s not uncommon to see a baby move his head to the side— but if he can’ t move it back into position, the baby may be experiencing the twist and stiffness of torticollis. These recurrent episodes of head tilt to one side among infants may be accompanied by vomiting. So a trip to the physician is important to rule out gastrointestinal reflux. Usually these babies are born into families where there is a previous history of migraine, and research suggests there may be a specific gene associated with the disorder. But the condition is still so rare that only 103 cases have been noted in literature.
Benign paroxysmal vertigo: This disorder, which occurs in younger children ages two to five, involves sudden episodes of loss of balance, usually accompanied by vomiting and pallor. After sleep, their balance returns to normal. Research published in the March 2011 issue of the journal Cephalalgia found that attacks ended around the median age of six years, though there was wide variation. And a majority of the children reported having recurrent headaches even after the vertigo resolved.
typically develops and can occur on either side of the body. Perhaps most frightening, the weakness may persist even after the headache is treated.
4. BASILAR MIGRAINE
Strange symptom: appearing intoxicated A third form of migraine with aura is basilar migraine. In this case, instead of an aura that involves a distorted body image, the aura involves episodes of severe dizziness, double vision and difficulty with balance and walking lasting up to about an hour. Children as young as seven can have this condition. They may describe their pain as“ behind the eyes,” appear intoxicated or even pass out.
The National Headache Foundation has a list of headache specialists who may be of help. See www. headaches. org or call 888-NHF-5552.
www. headaches. org | National Headache Foundation 23