Migrainous Infarction in a 13-Year-Old Boy: A Rare Case of Complicated Childhood Migraine

Introduction: Migrainous infarction is a rare but recognized complication of migraine with aura and is exceedingly uncommon in the pediatric population. Diagnostic uncertainty is frequent, as migraine in children is often perceived as a benign primary headache disorder. Rationale: Early recognition of migrainous infarction in children is critical to prevent unnecessary investigations, delayed treatment, and long-term neurological morbidity. This case highlights the diagnostic challenges posed by prolonged and severe childhood migraine associated with radiological evidence of cerebral infarction. Case Report: We report a 13-year-old boy with a five-year history of progressively worseningmigraine-like headaches who presented with severe, disabling headache and vomiting. Neuroimaging revealed multiple small cerebral infarcts in the absence of vascular, metabolic, infectious, or autoimmune pathology. After comprehensive evaluation, a diagnosis of complicated migraine with migrainous infarction was made. The patientshowed marked clinical improvement with migraine prophylaxis using flunarizine and sodium valproate. Conclusion: This case underscores that migraine in children can be complicated by cerebral infarction even in the absence of focal neurological deficits. Persistent or worsening headachesin children warrant careful evaluation, and migrainous infarction should be considered once secondary causes are excluded.