Confusional migraine, or acute confusional migraine (ACM), is a rare type of migraine headache that typically affects children and teenagers. Symptoms include confusion, agitation, and disorientation.

According to the Migraine Research Foundation, 10% of children in the United States experience migraine. An older study from 2012 notes that ACM affects approximately 0.45% to 7.8% of children with migraine.

Understanding symptoms of ACM can help a person know when they have common headaches or when they need further medical evaluation.

This article takes a closer look at the symptoms, causes, and treatment options for ACM.

A person with a blurry head who may have a confusional migraine.Share on Pinterest
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Healthcare professionals classify migraine as moderate-to-severe pain that is often located on one side of the head. The pain can last for 4–72 hours.

Other symptoms usually include:

People may also experience auras, which can cause visual, language, and sensory disturbances.

ACM is a rare type of migraine in which the main symptom is confusion. It can also cause:

  • headache
  • agitation
  • speech difficulties
  • loss of memory

The symptoms of ACM can vary. Typically, a person will experience headache accompanied by:

  • confusion
  • disorientation
  • agitation

A person can experience the headache before, during, or after the state of confusion. However, the headache occurs beforehand for most people.

Other symptoms may include:

By the end of the migraine episode, people may feel drowsy or fall asleep. They may also not remember what has happened.

Any child showing these symptoms should undergo an evaluation from a physician or specialist to accurately diagnose symptoms and explain various treatment options.

How long do the episodes last?

A 2020 literature review notes that symptoms of ACM typically resolve within 24 hours.

The confusion can last between a few minutes and 72 hours.

A 2018 review notes there is little research about how to treat ACM.

According to a 2020 review, there are no specific treatment therapies for ACM because it resolves without intervention.

However, a healthcare professional may recommend the following medications to help treat and prevent episodes of ACM in children:

  • Topiramate: Topiramate is a form of anti-epileptic medication. When topiramate is used as a preventive treatment, a healthcare professional may prescribe 15 milligrams (mg) per day. This may increase over time to 2–3 mg per kilogram (kg) (mg/kg) once per day.
  • Valproic acid and sodium valproate: This is another form of anti-epileptic medication. A healthcare professional may prescribe 10–15 mg/kg, divided into two doses per day. However, valproic acid is not suitable for females, as it can cause adverse effects such as weight gain, hair loss, and liver insufficiency.
  • Prochlorperazine: This is an antinausea medication. A healthcare professional can administer this medication intravenously.

It is important to note that the above doses are for children. Adults with ACM will receive different doses.

Other potential treatment options include:

Part of treating ACM may also include figuring out the cause.

There is ongoing research into the cause of ACM.

However, research from 2012 states that approximately half of ACM cases occur due to mild head trauma. In addition, 54% of people with ACM had a personal history of migraine, and 62% had a family history of migraine.

ACM also appears to affect males slightly more often.

To get the correct diagnosis, a doctor may use the process of elimination. This is because similar symptoms appear in other conditions, such as:

Doctors may use techniques that help diagnose all types of migraine.

The physician will ask about information regarding a person’s:

  • medical and psychological history
  • family medical history
  • lifestyle

The doctor will also look at:

  • current and past medications
  • injuries
  • accidents
  • abuse

Documenting migraine history and details can help discover patterns or reasons for migraine.

Doctors may also order images, tests, and scans to make sure there are not any tumors or irregularities in the brain. MRI and CT scans are examples of imaging procedures.

Testing blood work also ensures no underlying medical conditions are causing migraine.

The results of the evaluation and tests can help create a treatment plan.

As there is ongoing research regarding the triggers of ACM, there are no specific guidelines on how to prevent them.

However, topiramate and sodium valproate are two medications that may help prevent ACM from occurring.

Additionally, the antihypertensive medication propranolol may also help prevent ACM.

Epilepsy is a condition in which a person experiences seizures.

According to a 2018 review, healthcare professionals characterize both migraine and epilepsy as conditions that occur unexpectedly.

These conditions share some similarities, including similar:

  • cognitive dysfunction, which is when a person has difficulty remembering
  • clinical features, such as lethargy
  • risk factors and incidence rates

Migraine can also occur alongside epilepsy.

The symptoms of ACM can mimic a focal unaware seizure. A person experiencing either an ACM episode or the aftermath of a focal unaware seizure may:

  • have a headache
  • feel tired
  • feel unwell
  • sleep
  • feel confused
  • not remember what happened

However, during a seizure, a person may experience shaking, stiffened muscles, and fumbling or chewing motions.

Additionally, the duration of each seizure differs. Seizures last approximately 2 minutes, whereas ACM episodes last up to 72 hours.

Healthcare professionals do not know the long-term course of ACM.

ACM is a rare condition that requires further research to develop new medications and treatments.

New medications and treatments to help treat and prevent ACM episodes are on the horizon. One example is neuromodulation, a procedure that stimulates the nervous system through the skin, similar to vagus nerve stimulation.

Doctors see the benefits of multilayered treatments as well as the connection between the mind and body. Prescriptions are beginning to include holistic and alternative therapies to treat migraine.

If a person experiences an ACM episode, they should contact a doctor. This is because the symptoms can appear similar to other conditions, such as epilepsy, encephalitis, or stroke.

Contacting a doctor is also important if ACM episodes:

  • occur more often
  • produce more intense symptoms
  • continue after taking medication or therapy
  • interfere with school or home activities
  • prevent good sleep

ACM is a rare type of migraine that mainly affects children and teenagers. It causes symptoms such as:

  • confusion
  • speech problems
  • agitation
  • extreme fatigue

Although there are no specific guidelines for the treatment and prevention of ACM episodes, healthcare professionals can prescribe topiramate, sodium valproate, or propranolol.

People should speak with a doctor soon after experiencing symptoms of ACM or anytime there is a change in symptoms or symptom intensity.

Finally, anyone wanting more information on ACM should not hesitate to seek guidance from a doctor.