# Acute Confusional Migraines: A Case Report

## TL;DR

This case report describes a rare and challenging migraine variant causing acute confusion and neurological symptoms in a teenager.

## Contribution

The paper contributes a clinical case highlighting the need for formal recognition of acute confusional migraine in diagnostic standards.

## Key findings

- A 14-year-old patient presented with ACM symptoms that resolved after treatment with a migraine cocktail.
- The case illustrates the difficulty in diagnosing ACM due to its similarity to stroke and lack of standardized protocols.
- Formal recognition of ACM could improve patient care and promote further research.

## Abstract

Acute confusional migraine (ACM) is a rare variant of migraine that is benign and self-resolving but difficult to diagnose. Without known causative pathophysiology and a lack of recognition in the International Classification of Headache Disorders (ICHD-3), ACM offers a puzzling clinical presentation. There currently is no standardized treatment for ACM, but with a growing anecdotal dataset there is the opportunity to formally recognize and establish protocols to improve patient care and outcomes.

A 14-year-old female presented to the emergency department (ED) with acute onset of confusion, vision changes, right-sided weakness, and dysarthria one hour prior to arrival. A stroke workup at the initial ED offered no pertinent findings. The patient was transferred to a pediatric specialty ED where all symptoms, aside from numbness and a mild headache, resolved during transfer. After administration of a migraine cocktail at the pediatric specialty ED, all remaining symptoms completely resolved. The patient was discharged home from the ED the same evening with outpatient follow-up.

This case presents the difficulty of diagnosing and treating ACM prior to its self-resolution. It highlights the need for formal recognition of the condition by the ICHD-3. In doing so, greater recognition will promote more research, awareness, and establishment of a standardized treatment for ACM.