Of 76 children admitted with migraine between 1982 and 1990, 13 had a discharge diagnosis of confusional migraine at British Columbia Children’s Hospital, Vancouver, Canada. A retrospective analysis of cases showed a preponderance of males to females (11:2), age range of 6 to 15 years (mean, 10 years), all having headache followed by a period of confusion, lasting 2-24 hours, and 4 having recurrent episodes. Mild head trauma preceded the headache in 4 patients. In addition to confusion, agitation occurred in 8 patients, past history of headache in 7, and a family history of migraine in 10. One of 11 patients with CT scans had an arachnoid cyst. EEG was mildly abnormal in 2 of 4 patients with recordings. CSF was normal in 2 patients studied. 
COMMENT. A diagnosis of migraine should be considered in children with episodes of acute confusion and agitation, lasting from 1 to 24 hours, preceded by headache and sometimes, mild head trauma, and a positive family history of migraine. It is interesting that CT scans uncovered an arachnoid cyst in one patient, a space-occupying lesion, usually developmental in origin, and known to be complicated by headaches and seizures in some. Further studies of the EEG, obtained in only 4 of the above patients, and response to therapy would be of interest.