Japanese Journal of Medical Research
Open AccessHemiplegic Migraine in Children: Clinical Presentation, Diagnosis, and Management Challenges in Pediatric Practice
Authors: Christopher L Edwards, Ashley S Membreno Lopez, Cara Green, Isabella Maymi, Kyla Whitten, Noa Wax, Stephanie Johnson.
Abstract
Hemiplegic migraine represents one of the most distinctive and diagnostically challenging forms of migraine with aura encountered in pediatric neurology practice yet remains critically understudied in Black children and other underserved populations. Characterized by transient unilateral motor weakness accompanying the typical migraine aura complex, this rare condition affects children as young as five to seven years of age and presents unique diagnostic and therapeutic considerations. The condition manifests in both familial and sporadic forms, with familial hemiplegic migraine linked to mutations in CACNA1A, ATP1A2, and SCN1A genes, while sporadic cases occur without identifiable family history. The clinical presentation often mimics stroke, epilepsy, or encephalopathy, leading to frequent misdiagnosis, with Black and Hispanic children experiencing significantly lower rates of accurate migraine diagnosis compared to White children in emergency settings. This comprehensive review examines the current understanding of pediatric hemiplegic migraine, including its pathophysiology, clinical manifestations, diagnostic approaches, and management strategies, with particular emphasis on the documented healthcare disparities affecting minority populations. Attention is given to the differential diagnosis challenges in children, the role of genetic testing, and the critical need for culturally competent care to address the substantial inequities in recognition, testing, and treatment that disproportionately impact Black children with this condition.
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