Acute Confusional Migraine

Acute confusional migraine is a rare pediatric migraine variant characterized by sudden-onset disorientation, agitation, and fluctuating consciousness, frequently accompanied by headache, visual symptoms, and phonophobia. Pathophysiology is hypothesized to involve cortical spreading depression and transient cerebral perfusion abnormalities. Diagnosis is primarily clinical, with neuroimaging used to exclude structural lesions, seizures, or encephalopathy. Management is symptomatic, including rest, hydration, and analgesics or migraine-specific therapy. Most episodes are self-limiting, and prognosis is favorable, although recurrent episodes may affect academic performance.