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Less common
varieties of migraine are the so‑called migraine equivalents and unusual
varieties of complicated migraine. "Migraine equivalent" is a term used to
denote conditions or symptomatology believed to be migrainous in origin but
without the typical history of either classic or common migraine headache.
While the idea of migraine equivalents has not always been well received,
according to Sacks5 the concentrated experience of working with
migraine patients must convince the physician, whatever his previous beliefs,
that many patients do suffer repeated, discrete, paroxysmal attacks of abdominal
pain, chest pain, fever, etc., which will fill every clinical criteria of
migraine save for the presence of headache.
The most well‑recognized type of migraine equivalent is abdominal migraine,
in which cyclical vomiting, periodic attacks of nausea, or abdominal pain
occur (usually in children or in adolescents). These patients experience
more typical attacks of migraine in later life. If the past
history of
migraine patients is investigated, a history of cyclical vomiting is far more
commonly found than in a control headache population.154 Very rarely
true abdominal migraine occurs in adult life. In this situation there may be
sudden severe abdominal pain with vomiting and even abdominal rigidity. The
usual brevity of the attack or previous similar benign episodes or strong
history of migraine help confirm the diagnosis.155 Other migraine
equivalents include periodic diarrhea, fever, mood changes, and possibly attacks
of chest pain known as precordial migraine. Acute confusional states have been
attributed to migraine in juveniles.156
Migraine
attacks may clearly occur without headache. Whitty157 detailed
the case histories of 16 patients who experienced auras of different
varieties, with and without headache, in whom strong family histories of
migraine, other migraine attacks, or otherwise asymptomatic follow‑up
allowed the diagnosis of migraine. Other atypical symptoms of complicated
migraine have been separated into subgroups such as facioplegic migraine,
cerebellar migraine, dysphrenic migraine, and migraine with involuntary
movements.88 Such unusual cases must be reviewed individually
and carefully evaluated before concluding that such episodes truly are
migrainous.
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