Discerning Arterial Ischemic Stroke From Migraine in Pediatric Emergency Departments

Distinct presenting features can differentiate migraine from arterial ischemic stroke in pediatric emergency departments, allowing clinicians to make informed decisions regarding urgency and neuroimaging of children with brain attack symptoms, according to a study published in Developmental Medicine & Child Neurology.

Children with migraine included in the study (n=84) consisted of individuals presenting to pediatric emergency departments between June 2009 and December 2010, and children with arterial ischemic stroke included in the study (n=55) consisted of individuals presenting to the same pediatric emergency departments between January 2003 and December 2010. The median age for the migraine group was 13 years 5 months, and 5 years for the arterial ischemic stroke group. 

Migraine was defined using the International Classification of Headache Disorders (ICHD) criteria, and children with headache that did not meet ICHD criteria were excluded, as were children with arterial ischemic stroke who had incomplete medical records or who were immediately admitted to the ward.

In children with migraine, more than 40% had numbness, vomiting, or visual disturbance, and 55% showed no signs at clinical assessment. Vomiting, sensory disturbances, absent focal signs, and older age were associated with decreased chance of arterial ischemic stroke. In the arterial ischemic stroke group, speech disturbance and weakness were common symptoms, and other clinical features associated with arterial ischemic stroke included sudden symptom onset, seizures, ataxia, walking difficulties, dysphasia, dysarthria, altered consciousness, and face, arm, and leg weakness.

Study investigators conclude, “migraine and [arterial ischemic stroke] have different clinical features in children presenting to the emergency department with brain attack symptoms. This may inform the development of paediatric Code Stroke protocols to assist emergency department physicians make decisions about the urgency and type of diagnostic brain imaging.”

Reference

Mackay MT, Lee M, Yock-Corrales A, et al. Differentiating arterial ischaemic stroke from migraine in the paediatric emergency department [published April 14, 2018]. Dev Med Child Neurol. doi: 10.1111/dmcn.13772