Complex Confusional Migraines
Sometimes it might feel like a migraine diagnosis just makes things – well, more complex and confusing! That certainly can be the case if you have been diagnosed with complex confusional migraine. So let’s try to clear things up a little bit.
First, we do need to insert a note of caution. Sometimes doctors will use migraine terminology that is outdated or just very unspecific. For example, the term “complex migraine” can simply mean that the migraine attacks are not what the doctor is familiar with, or that there are other symptoms that suggest something other than migraine as well as migraine itself.
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But complex confusional migraine is a little more complicated.
The disorder that we sometimes call confusional migraine or acute confusional migraine is very rare, which is one reason why the terminology hasn’t been standardized across the board. It seems to be most common in children and teens, but can occur at other ages.
Typical symptoms are summarized in a report from the journal Pediatrics:
ACM presents as a sudden confusional state, usually accompanied by agitation, visual symptoms, dysarthria [resulting in slow or slurred speech], and memory disturbance. In most cases, headache precedes or follows the attack. The attack lasts 30 minutes to 24 hours. Head trauma has been recognized as a strong predisposing factor. Physical examination is normal in virtually all cases.
Confusional migraine is known as a “diagnosis of exclusion”, which basically means that you’ve been carefully examined and tests have been done and it doesn’t appear to be anything else. There is no test to definitely diagnose complex confusional migraine.
However, about half of the cases seem to come after some kind of head injury.
Complex confusional migraine is not a term used in the standard for migraine diagnosis, The International Classification of Headache Disorders from the International Headache Disorder. Some have argued that confusional migraine should be included as a distinct type of migraine.
However, we need to be careful, because there are other types of migraine that may cause confusion, agitation, or speech or memory problems. Even more importantly, there are other diseases and disorders which could cause these symptoms, which is why very careful testing needs to be done.
So what should I do if I’ve been diagnosed with CCM?
First, be sure that proper testing has been done. This means taking a medical history, a physical exam, and possibly blood tests, imaging tests, an EEG, and so on. The doctor or specialist will need to know what you’ve been recently exposed to, if you’ve had any injury, if you have other types of headaches, and what medication you may be taking.
Second, be sure to ask your doctor for details about your diagnosis. Is she familiar with other types of migraine?
Finally, prepare yourself to try some of the migraine treatments that your doctor or specialist will suggest. If your attacks continue, consider a second opinion. If symptoms change or get worse, see the doctor right away.
Treating Complex Confusional Migraine
Because CCM is relatively rare, there is no standard for treating it. If it is recurring, many of the familiar migraine treatments may be tried, such as triptans. Because of its similarity to symptoms of epilepsy, anti-seizure medications may be tried as well. These types of medications are common for treating many types of migraine.
If you’ve been diagnosed with complex confusional migraines, we would like to hear about your experiences. Be sure to leave a comment!
Also see: Acute confusional migraine: our knowledge to date.
