Confusional migraine is a rare type of migraine that can cause sudden confusion, disorientation, agitation, or changes in awareness during an attack. Because these symptoms can also happen with a stroke, seizure, infection, or another serious brain problem, it’s important to get medical help right away.

Confusional migraine is more often reported in children and teens, but adults can get it, too.

Here are some key symptoms and steps doctors may take to diagnose confusional migraine.

Most Common Signs and Symptoms

Until a healthcare provider evaluates you, it can be hard to tell confusional migraine apart from another medical emergency. Here are some signs that may point to a confusional migraine attack, but it’s important to get medical care right away.

Sudden Confusion

As the name suggests, the main symptom of confusional migraine is sudden confusion. You may:

• Seem less aware of what’s going on
• Not know where you are, what’s happening, or what you were just doing
• Seem dazed, distracted, or slower to respond
• Struggle to follow simple instructions

Confusional migraine can also make it hard to recognize familiar people or places.

The symptoms may come and go or get stronger and weaker over time. These changes can be especially upsetting when they happen to someone you know and love.

The confusion usually does not last long. Many episodes last a few minutes to several hours, and often go away within about a day. If confusion lasts much longer than expected or keeps getting worse, it’s important to get checked again right away.

Behavior Changes

Many people also get restless or agitated during an episode. Agitation means feeling upset, restless, or unusually active.

You may pace, act unusually, or respond in ways that don’t fit the situation. In some cases, you may have visual hallucinations (see things that aren’t really there).

Behavior changes can be mistaken for another medical or mental health condition. It can even make it seem like you’re under the influence of alcohol or drugs.

Trouble Communicating

Confusional migraine can affect communication. You may struggle to find words, speak clearly, or understand what others are saying.

Problems with speaking or understanding language can happen during a confusional migraine. This is called aphasia. Aphasia can also be a sign of a stroke or another serious brain problem, so it’s important to get medical care right away.

Memory Loss

Once a confusional migraine is over, you may not remember it. You may be surprised to hear how you acted and may need help piecing together what happened.

If you have a child with confusional migraine, it can seem like they go back to normal when the attack is over.

Headache and Other Migraine Symptoms

Headaches and other common symptoms of migraine can happen before or after the confusion phase. These can include:

• Sensitivity to light
• hrobbing head pain
• Nausea

Many people feel very tired afterward, during the postdrome, or recovery phase, of a migraine. Children may fall asleep and wake up feeling better. Adults may need time to rest and recover.

Steps to Diagnosis

There is no single test that can confirm confusional migraine. Doctors usually diagnose it by looking at the person’s symptoms and medical history and by ruling out more serious causes of sudden confusion. Also, because there is no single official way to diagnose this condition, different providers may describe it in slightly different ways.

If doctors can’t find another reason for the confusion, they may diagnose confusional migraine, especially if other migraine symptoms happen around the same time.

The process starts with a detailed medical history and neurological exam. A healthcare professional will ask questions, such as:

• When did the symptoms start and stop, and how did they progress?
• Are there recent triggers such as sleep deprivation, stress, or medications?
• What other symptoms does the person have?
• Is there a personal or family history of migraine or other health conditions?
• Was there any recent head trauma?
• Is this the first time the person has had confusion?

Based on the answers, they’ll decide if other tests should be ordered. These may include:

• Brain imaging studies, such as a CT scan or an MRI
• An electroencephalogram (EEG) to check brain activity
• Blood or urine tests to check for health problems, toxins, and infections
• Lumbar puncture to test the cerebrospinal fluid, the clear fluid around the brain and spinal cord
• Neurological tests to check thinking, reflexes, and coordination

For children, the diagnosis may become clearer over time if episodes happen again in a similar way. In adults with no history of migraine, a healthcare provider may be less likely to diagnose confusional migraine, especially because it’s less common in adults.

What MyMigraineTeam Members Say About Diagnosis

Confusional migraine is rare, and not all healthcare providers are familiar with it. It can take multiple medical appointments and specialist visits to get an accurate diagnosis. Members of MyMigraineTeam have talked about what it was like to get diagnosed.

“Despite being diagnosed with chronic, confusional migraines by a neurologist, the other headache specialists I’ve gone to keep wanting to label it as entirely anxiety,” shared one member. “My counselor has told me that while a few of my symptoms could be anxiety, because they are also considered migraine symptoms, she won’t diagnose me with anxiety unless migraine is ruled out.”

Another member responded, “My neurologist told me that a lot of doctors are quick to diagnose migraine symptoms as anxiety disorders or tension headaches, and it robs the patient of the care and treatment they need. My advice would be to find a doctor who takes you seriously.”

Confusional Migraine Treatment Options

Once you get an accurate diagnosis, you can work on preventing migraine attacks and treating your symptoms. During an attack, there is no standard treatment for the confusion itself.

But after doctors make sure it’s not something dangerous (like a stroke or seizure), they may treat it like other migraine attacks. This can include common migraine medicines used for pain or nausea, along with rest in a quiet place.

If confusional migraine episodes are happening regularly, you may need to take steps to help prevent them. As with other types of migraine, confusional migraine can have certain triggers. Keeping a journal of your symptoms can help identify potential triggers. Common triggers may include weather changes, hormone changes, or lack of sleep.

Try to keep a regular routine with meals, exercise, sleep, and stress. Medicines and other treatments may also help, so it’s a good idea to talk with a migraine specialist.

Staying Safe With Confusional Migraine

It’s important to let trusted friends and family members know if you have confusional migraine, so they can help keep you calm and safe if the confusional state happens. This is especially true when you’re away from home.

For school-aged children, this means informing the school nurse and other key staff members of the child’s condition. Work with the child’s doctor to create a treatment plan.

Adults with confusional migraine may benefit from wearing a medical alert bracelet. This type of identification lets first responders know about the condition.

When To Get Urgent Care

Some signs of a medical emergency should never be ignored, even if you’ve already been diagnosed with confusional migraine.

Get emergency help right away if confusion happens along with any of these symptoms:

• Fever or signs of infection
• Difficulty speaking or understanding speech
• Loss of consciousness
• Recent head injury
• Seizures
• Severe headache
• Weakness on one side of the body, which can happen with hemiplegic migraine, a rare type of migraine that may run in families
• Confusion that lasts longer than expected

If weakness, trouble speaking, or confusion is new for you or feels different than usual, treat it like an emergency and get help right away.

With the right plan in place, children and adults with confusional migraine can get the care they need to feel more confident and stay independent. It all starts with finding a good healthcare team and support network.

Join the Conversation

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