Modern Pediatrics. Ukraine. (2026).1(153): 163-168. doi: 10.15574/SP.2026.1(153).163168
Pypa L. V., Svistilnik R. V., Lysytsia Ju. N., Kuleshov O. V., Ruda V. I.
National Pirogov Memorial Medical University, Vinnytsya, Ukraine

For citation: Pypa LV, Svistilnik RV, Lysytsia JuN, Kuleshov OV, Ruda VI. (2026). A clinical case of polymorphism in migraine manifestations, its relationship and evolutionary connection with episodic syndromes that may be associated with migraine. Modern Pediatrics. Ukraine. 1(153): 163-168. doi: 10.15574/SP.2026.1(153).163168.
Article received: Oct 23, 2025. Accepted for publication: Feb 08, 2026.

Migraine is a genetic brain disease with complex pathogenesis, polymorphic clinical manifestation and difficulty in diagnosing in children, as it may manifest itself in them not in classical variants, but in episodic syndromes – migraine phenotypes.
Aim – to inform the medical community about atypical clinical forms of migraine associated with episodic syndromes, for their timely diagnosis and, accordingly, rational therapy. 
The article presents an analysis of a clinical case involving the development of migraine and related episodic syndromes. The peculiarity of this case lies in the ability to clearly trace, over the patient’s lifetime, the evolutionary stages of the development of migraine with aura, which was preceded by episodic syndromes potentially associated with migraine. The case illustrates the clinical polymorphism of migraine progression, the diagnostic challenges, and, as a consequence, the development of complications such as status migraineurs. The importance of timely diagnosis of such conditions in children and the prospects for further research are discussed.
Conclusions. Episodic syndromes in children included in ICHD-III, in particular, cyclic vomiting syndrome, abdominal migraine, may be the first stages of migraine development. The occurrence of individual episodic syndromes in a certain age range may indicate a certain evolutionary process of migraine development.  The role of early preventive treatment of these episodic syndromes on their subsequent transformation into classic migraine with aura remains unstudied.
The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the children's parents.
The authors declare no conflict of interest.
Keywords: migraine, episodic syndromes, children, clinic.

REFERENCES

1. Abu-Arafeh I, Gelfand AA. (2021). The childhood migraine syndrome. Nat Rev Neurol. 17(7): 449-458. https://doi.org/10.1038/s41582-021-00497-6; PMid:34040231

2. Azmy DJ, Qualia CM. (2020). Review of Abdominal Migraine in Children. Gastroenterol Hepatol (N Y). 16(12): 632-639.

3. Frattale I, Ruscitto C, Papetti L, Ursitti F, Sforza G, Moavero R et al. (2021). Migraine and Its Equivalents: What Do They Share? A Narrative Review on Common Pathophysiological Patterns. Life (Basel). 11(12): 1392. https://doi.org/10.3390/life11121392; PMid:34947923 PMCid:PMC8705894

4. Hasler WL, Levinthal DJ, Tarbell SE, Adams KA, Li BUK, Issenman RM et al. (2019). Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions. Neurogastroenterol Motil. 31; Suppl 2 (Suppl 2): 13607. https://doi.org/10.1111/nmo.13607; PMid:31241816 PMCid:PMC6899706

5. Headache Classification Committee of the International Headache Society (IHS) (2018, Jan). The International Classification of Headache Disorders. 3rd edition. Cephalalgia. 38(1): 1-211. https://doi.org/10.1177/0333102417738202

6. Howells R, Abu-Arafeh I. (2022). The migraine syndrome in children. Paediatrics and Child Health. 32(10): 388-393. https://doi.org/10.1016/j.paed.2022.07.011

7. Kaniecki R. (2024). Migraine with brainstem aura. Handb Clin Neurol. 199: 367-379. https://doi.org/10.1016/B978-0-12-823357-3.00019-7; PMid:38307657

8. Karrento K, Rosen JM, Tarbell SE, Issenman RM, Gelfand AA, Gamboa H et al. (2025). North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition 2025 guidelines for management of cyclic vomiting syndrome in children. J Pediatr Gastroenterol Nutr. 80(6): 1028-1061. https://doi.org/10.1002/jpn3.70020; PMid:40223700

9. Xu SY, Li HJ, Huang J, Li XP, Li CX. (2021, Apr 20). Migraine with Brainstem Aura Accompanied by Disorders of Consciousness. J Pain Res. 14: 1119-1127. https://doi.org/10.2147/JPR.S305483; PMid:33907459 PMCid:PMC8068516

10. Youssef PE, Mack KJ. (2020). Episodic and chronic migraine in children. Dev Med Child Neurol. 62(1): 34-41. https://doi.org/10.1111/dmcn.14338; PMid:31463934