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The relationship between migraine and epilepsy has been recognized since the 20th century. Currently, both pathologies share several characteristics, from molecular and electrophysiological mechanisms to their similarity in clinical symptoms and response to treatment. This is a case report of an 11-year-old male patient who presented with focal epilepsy at the age of 8 years. One year later, he developed episodes of migraine without aura followed by seizures with a frequency of 1–2 times per month, with headache duration ranging from 10 min to 6 h. At age 11, he also presented other episodes in which the headache occurred after the epileptic event and other episodes in which the headache was present both before and after the epileptic seizure. An interictal EEG study and an EEG study during a migraine attack showed the presence of high-voltage theta activity and bilateral temporo-parieto-occipital spikes with a greater expression in the right cerebral hemisphere. To our knowledge, this is the first report of an atypical presentation of migraine without aura and epileptic seizure. This case opens new challenges in the search for understanding between both pathologies.

Abstract Background Migraine and epilepsy are two paroxysmal chronic neurological disorders affecting a high number of individuals and being responsible for a high individual and socioeconomic burden. The link between these disorders has been of interest for decades and innovations concerning diagnosing and treatment enable new insights into their relationship. Findings Although appearing to be distinct at first glance, both diseases exhibit a noteworthy comorbidity, shared pathophysiological pathways, and significant overlaps in characteristics like clinical manifestation or prophylactic treatment. This review aims to explore the intricate relationship between these two conditions, shedding light on shared pathophysiological foundations, genetic interdependencies, common and distinct clinical features, clinically overlapping syndromes, and therapeutic similarities. There are several shared pathophysiological mechanisms, like CSD, the likely underlying cause of migraine aura, or neurotransmitters, mainly Glutamate and GABA, which represent important roles in triggering migraine attacks and seizures. The genetic interrelations between the two disorders can be observed by taking a closer look at the group of familial hemiplegic migraines, which are caused by mutations in genes like CACNA1A, ATP1A2, or SCN1A. The intricate relationship is further underlined by the high number of shared clinical features, which can be observed over the entire course of migraine attacks and epileptic seizures. While the variety of the clinical manifestation of an epileptic seizure is naturally higher than that of a migraine attack, a distinction can indeed be difficult in some cases, e.g. in occipital lobe epilepsy. Moreover, triggering factors like sleep deprivation or alcohol consumption play an important role in both diseases. In the period after the seizure or migraine attack, symptoms like speech difficulties, tiredness, and yawning occur. While the actual attack of the disease usually lasts for a limited time, research indicates that individuals suffering from migraine and/or epilepsy are highly affected in their daily life, especially regarding cognitive and social aspects, a burden that is even worsened using antiseizure medication. This medication allows us to reveal further connections, as certain antiepileptics are proven to have beneficial effects on the frequency and severity of migraine and have been used as a preventive drug for both diseases over many years. Conclusion Migraine and epilepsy show a high number of similarities in their mechanisms and clinical presentation. A deeper understanding of the intricate relationship will positively advance patient–oriented research and clinical work.

Edward Henry Sieveking (1816–1904) was a professionally successful and well respected nineteenth-century London physician who, over the span of some half a century, continuously held appointment to British royalty, including Queen Victoria and King Edward VII. In 1858, he published a monograph On Epilepsy and Epileptiform Seizures, with a second edition in 1861. In both editions, he described an entity cephalalgia epileptica that comprised the occurrence of headache in association with phenomena that resembled the premonitory symptom of some epileptic seizures. However, the sufferers did not have epilepsy, in that they did not experience generalized convulsions. Sieveking, like most of his British contemporaries, had little awareness of the existence of the variety of migraine phenomena apart from headache itself. In retrospect, it seems likely that migraine with aura probably was the main basis of the disorder Sieveking designated, one that later may have been termed migralepsy. [ABSTRACT FROM AUTHOR]

Introduction: Migraine and epilepsy are common chronic neurological disorders presenting with paroxysmal attacks of transient cerebral dysfunction, followed by subsequent return to baseline between episodes. The term "migralepsy" has been proposed to definemigraine-triggered epileptic seizures classified by the ICHD-III as a complication of migraine with an aura. Case: A 55-year-old man with a 30-year history of migraine without aura presented with a new onset left parietal pain accompanied by visual disturbances occurring up to 20 times per day. His visual distortions included kaleidoscopic vision, flashes of shadows, and a right superior quadrantanopia lasting 20min. He described discrete 2-min episodes of scintillating scotomas in his right visual field. Ictal EEG demonstrated a left occipital onset focal aware seizure with his clinical symptoms. The patient was started on valproic Acid and has remained asymptomatic. Discussion: The diagnostic criteria as set out by the ICHD-III for migralepsy and other syndromes with migrainous and ictal features remain confusing for practitioners as there is much overlap in clinical manifestations of these entities. EEG should be obtained when ictal features are noted among patients presenting with headache. [ABSTRACT FROM AUTHOR]

IntroductionMigraine and epilepsy are common chronic neurological disorders presenting with paroxysmal attacks of transient cerebral dysfunction, followed by subsequent return to baseline between episodes. The term “migralepsy” has been proposed to define migraine-triggered epileptic seizures classified by the ICHD-III as a complication of migraine with an aura.CaseA 55-year-old man with a 30-year history of migraine without aura presented with a new onset left parietal pain accompanied by visual disturbances occurring up to 20 times per day. His visual distortions included kaleidoscopic vision, flashes of shadows, and a right superior quadrantanopia lasting 20 min. He described discrete 2-min episodes of scintillating scotomas in his right visual field. Ictal EEG demonstrated a left occipital onset focal aware seizure with his clinical symptoms. The patient was started on valproic Acid and has remained asymptomatic.DiscussionThe diagnostic criteria as set out by the ICHD-III for migralepsy and other syndromes with migrainous and ictal features remain confusing for practitioners as there is much overlap in clinical manifestations of these entities. EEG should be obtained when ictal features are noted among patients presenting with headache.

We report three cases of pediatric patients suffering from migraine aura triggered seizures. This entity, also called migralepsy, still does not have a unique definition today. Migraine and epilepsy are both episodic neurological disorders with periods of interictal well-being; this is indicative of similar pathophysiological mechanisms, such as increased neuronal excitation and ion channel dysfunction. The purpose of this paper is to discuss the clinical and instrumental features of migralepsy through the description of three clinical cases in which the symptoms of the usual migraine aura developed into a generalized tonic–clonic or focal seizure. [ABSTRACT FROM AUTHOR]

Objective: Occipital lobe epilepsies (OLE) comprise 5–10% of focal epilepsies in surgical and paediatric series; with little data from adult medical cohorts. This longitudinal study examined OLE patients, to characterise prevalence, semiology, co-morbidity and prognosis in a neurology outpatient setting. Methods: 24 adult OLE patients identified over 12 months from 1548 patients in a neurologist's service were followed over 12 years. Results: 92% of these OLE patients had simple visual hallucinations, misdiagnosed in 40% of cases. 75% had co-morbid interictal migraine and 38% had visual field defects. Only 33% achieved long-term remission, and only 2 /10 (20%) of OLE patients with a structural aetiology were seizure-free. The two patients with migralepsy achieved remission. Conclusion: Adult OLE accounted for 7.7% of focal epilepsies in this cohort, misdiagnosed or misclassified in 40%. Most patients had co-existing migraine. A minority had migralepsy characterised by a longer aura and good prognosis. Remission rates were lower than that of childhood OLE and general adult epilepsy populations, strengthening the argument for considering epilepsy surgery in drug-resistant OLE patients with a structural cause. Precision medicine will potentially refine diagnosis and management in those OLE patients without an identified cause but is predicated on accurate clinical phenotyping. [ABSTRACT FROM AUTHOR]

We report three cases of pediatric patients suffering from migraine aura triggered seizures. This entity, also called migralepsy, still does not have a unique definition today. Migraine and epilepsy are both episodic neurological disorders with periods of interictal well-being; this is indicative of similar pathophysiological mechanisms, such as increased neuronal excitation and ion channel dysfunction. The purpose of this paper is to discuss the clinical and instrumental features of migralepsy through the description of three clinical cases in which the symptoms of the usual migraine aura developed into a generalized tonic–clonic or focal seizure.

Background: The complex relationship between migraine and epilepsy has frequently been described to represent a clinical and electrographic "borderland." These two conditions share clinical expressions such as paroxysmal and chronic nature, as well as semiology, particularly visual phenomenon.Objective: We aimed to review the current literature on the overlapping phenomena of migraine and epilepsy.Materials and Methods: We searched the PubMed for relevant literature and conducted a narrative review on migraine and epilepsy.Results: Migraine and epilepsy share a complex and pathophysiologically intriguing relationship. The International Classification of Headache Disorders, 3rd edition (ICHD-3) makes diagnostic provisions for migraine aura-triggered seizures (Subchapter 1.4.4) and headache attributed to epileptic seizure (Subchapter 7.6), the latter being further categorized as 7.6.1 Ictal epileptic headache, and 7.6.2  post-ictal headache. Neurological conditions such as certain channelopathies and epilepsy syndromes exhibit both conditions within their phenotypic spectrum, suggesting shared genetic and molecular underpinnings. Diagnostic confusion may arise, particularly between occipital epilepsy and the visual aura of migraine. Antiseizure medications may be effective for the treatment of migraines that occur in concert with epilepsy.Conclusions: Migraine and epilepsy share several clinical features and have intertwined genetic and molecular underpinnings, which may contribute to common pathogenesis. Electroencephalography may be useful as a diagnostic tool in selected cases. [ABSTRACT FROM AUTHOR]

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Purpose: To describe the concept, features and mechanisms of epileptic headache (EH).Methods: Analysis of all published articles concerning EH and related subjects.Results: There are more than 30 published case studies of patients with headache as the only manifestation of a seizure, a condition that has been variously called "EH", "ictal epileptic headache", "hemicrania epileptica", "cephalic pain seizure". It is necessary to differentiate EH from "migralepsy" and "ictal non-epileptic headache". EH may be an isolated event or the initial phase of a seizure followed by other manifestations. An isolated EH is clinically relevant because it is often symptomatic of structural brain disease; this underlines the importance of a differential diagnosis as the head pain of EH has no specific diagnostic characteristics. The described cases indicate that the location of the foci may vary, thus suggesting the involvement of different parts of the pain network. EH is a "focal aware" seizure, but there are a few reports of cases in which it was associated with generalised epileptiform activity. A correct diagnosis of EH requires an ictal EEG recording showing epilepsy-compatible discharges that coincide with the onset and cessation of the headache. A rapid response to the acute administration of an antiepileptic drug may support the diagnosis.Conclusions: EH is a particular type of pain seizure that has a complex pathophysiology and, when isolated, requires differential diagnostic consideration. We believe that, although it is not frequent, pain as an ictal symptom should be highlighted in the operational classification of seizure types. [ABSTRACT FROM AUTHOR]

Objective To evaluate the characteristics of visual auras (VA) in epilepsy and migraine. Background Both disorders are usually diagnosed on clinical grounds, but differentiation might be challenging in isolated auras or because of the similar presentation in migraine and epilepsy. Methods A retrospective study of two cohorts was performed to compare the VA characteristics of 27 epilepsy patients and 27 age-matched migraine patients. Results The duration of VA was significantly shorter in epilepsy (median: 56s; 1st quartile Q1: 26s; 3rd quartile Q3: 130s) than in migraine (20 min; Q1: 10 min; Q3: 30 min) ( P < .0001). A cutoff duration of ≥5 minutes identified all migraine patients (100% sensitivity, 92% specificity). VAs of epileptic etiology were characterized by restriction to a visual hemifield (74.1% vs 29.6% in migraine, P = .0024) with stereotypic affection of one hemifield (55.5% vs 7.4% in migraine, P = 0.0003). Centrifugal or centripetal spread of visual phenomena only occurred in migraine (37.0%), but not in epilepsy ( P = 0.0007). If present, accompanying symptoms such as nausea/vomiting (19/27) or photo-/phonophobia (17/27) identify migrainous auras (vs 0/27 in the epilepsy patients; P < .0001). Headache presented in all migraine patients, but was also observed in six of the epilepsy patients during cephalic auras or the postictal phase ( P < .0001). None of the visual migrainous auras evolved into an epileptic seizure, a concept called migralepsy. Conclusions Several clinical characteristics differentiate VA of epileptic and migrainous origin - if presenting in classical manner. Additional EEG evaluations should be performed in patients with VA of unclear etiology and epileptic VA features added to current classifications to increase their discriminatory power. [ABSTRACT FROM AUTHOR]

The interrelations between headache/migraine and epileptic seizures are an interesting topic, still lacking a systematization, which is the objective of the present revision. We organize the general setting on: (a) a distinction between pre-ictal, ictal, post-ictal and inter-ictal headaches, assuming "ictal" as epileptic seizure, and (b) the kind of headache, if it is of migraine type or not. Concerning pre-ictal migraine/headache, the necessity of its differentiation from an epileptic headache presenting as an aura of a seizure is stressed; this is connected with the indefiniteness of the term "migralepsy". The term "migraine aura-triggered seizure" should be used only in front of a proven triggering effect of migraine. Epileptic headache (called also "ictal epileptic headache") is a well-characterized entity, in which different types of head pain may occur and an ictal EEG is necessary for the diagnosis. It may present as an isolated event ("isolated epileptic headache"), requiring a differential diagnosis from other kinds of headache, or it may be uninterruptedly followed by other epileptic manifestations being in this case easily identifiable as an epileptic aura. Hemicrania epileptica is a very rare variant of epileptic headache, characterized by the ipsilaterality of head pain and EEG paroxysms. Ictal non-epileptic headache needs to be differentiated from epileptic headache. Post-ictal headaches are a frequent association of headache with seizures, particularly in patients suffering also from inter-ictal headache-migraine. The reported systematization of the topic led us to suggest a classification which is shown in Appendix. [ABSTRACT FROM AUTHOR]

• Headache is frequently ignored comorbidity in patients living with epilepsy. • Psychiatric comorbidities and resultant poor mental health in patients with headaches and epilepsy are under-reported. • Migralepsy, an under-studied concept, is an academic and a clinical gray zone. • Proper diagnosis, counseling, education, lifestyle modification, and drug therapy for headaches in patients living with epilepsy may help improve the quality of life. Headache disorders cause significant distress in patients living with epilepsy (PWE) and are underreported. This study aimed to evaluate the prevalence of various forms of headache in PWE. Two hundred and three PWE were evaluated for the presence and type of headache as per the International Classification of Headache Disorders (ICHD)-3 classification criteria. The severity was graded using the Headache Under Response to Treatment (HURT)–3. A subgroup analysis of headache and epilepsy was done. The World Health Organization-5 (WHO-5) questionnaire was used to assess mental well-being. The Mini International Neuropsychiatric Interview (MINI) questionnaire was used to study the psychiatric comorbidities, which were classified according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV classification. The prevalence of headaches in PWE was 45% [60% females]. Female gender and younger age were significantly associated with migraine (p values of 0.03 and 0.05, respectively). Migraine was the most common type of headache (71%), followed by tension-type headache (TTH) (23%) in PWE. The headache was inter-ictal in 80% of PWE. In PWE with migraine, both juvenile myoclonic epilepsy (JME) and frontal lobe epilepsy (FLE) had a 28% prevalence. In PWE with TTH, FLE was more common (43%). The prevalence of migralepsy in PWE was 4% [n = 4; 2 each of occipital lobe epilepsy (OLE) and idiopathic generalized epilepsy (IGE)]. A psychiatric illness was more than two times more likely in PWE with headache (n = 34; 37%) as compared to PWE without headache (n = 19; 17%). Patients living with epilepsy with headaches and psychiatric comorbidities had significantly lower mental well-being (p = 0.001). Forty five percent of PWE with headaches required acute management, and 35% required prophylactic management for their headache. Headache is frequently ignored in PWE. It can affect their mental health and quality of life. Evaluation and management of headache in PWE is very important. [ABSTRACT FROM AUTHOR]

Objective To provide a review on the spectrum of migraine-epilepsy disorders in children. Background The migraine-epilepsy continuum covers a fascinating array of disorders that share many clinical similarities but also differ fundamentally in pathophysiology. In the pediatric population, its study can be complicated by the young age of those affected and the lack of clear understanding of the neurobiology of these disorders within the developing brain. Discussion This review serves to discuss the borderland of migraine and epilepsy in children. It will focus on epidemiology and comorbidity of the two disorders, possible mechanisms for shared pathophysiology informed by basic and translational science, and an overview of clinical similarities and differences. It will also discuss differentiation of migraine aura from childhood occipital epilepsies. Finally, the review concludes with a discussion of current classification methods for capturing cases on the migraine-epilepsy spectrum and a call for a united approach towards a better definition of this spectrum of disorders. Conclusion Recent advances examining the migraine-epilepsy spectrum show clinicopathological similarities between the two disorders in children. Epidemiology demonstrates reciprocally increased incidences of epilepsy in migraineurs and of migraines in children with epilepsy, however, prospective longitudinal in children are currently lacking. Clinically, the two disorders show similarity in preictal, ictal, and postictal phenomena, with close temporal association of the two conditions described by the controversial term of 'migralepsy.' Basic science research has contributed significant improvements in understanding the generation of both of these episodic neurological conditions, with common links seen at a cellular level involving synaptic glutamate release and the provocation of varying propagation methods including cortical spreading depression in migraine and the paroxysmal depolarizing shift in epilepsy. Despite these significant gains in understanding, improved classification methods are required to identify and further study these interrelated conditions and move towards improved diagnosis and treatment of disorders on the migraine-epilepsy continuum in children. [ABSTRACT FROM AUTHOR]

Background The concept of migralepsy refers to visual migraine auras that seemingly evolve into epileptic seizures. It was discussed controversially ever since and scientific proof for this entity is scarce. Methods We report two patients with visual aura fulfilling the diagnostic criteria for migralepsy. In both patients, habitual attacks were recorded during long-term video electroencephalography ( EEG) monitoring. Case results Both patients demonstrated unilateral occipital EEG seizure patterns during their long-lasting visual aura, which eventually evolved into versive seizures. Conclusion Here, we prove the epileptic origin of the visual auras, which have been misdiagnosed as migraine or migralepsy before. Additional evaluation should be considered in patients with visual aura and hints for an epileptic origin as occipital lobe epilepsy might be missed in patients diagnosed with migraine. Based on our patients, we suggest to challenge the concept of migralepsy in current classifications. [ABSTRACT FROM AUTHOR]

Migraine and epilepsy are disorders that are common, paroxysmal, and chronic. In many ways they are clearly different diseases, yet there are some pathophysiological overlaps, and overlaps in clinical symptomatology, particularly with regard to visual and other sensory disturbances, pain, and alterations of consciousness. Epidemiological studies have revealed that the two diseases are comorbid in a number of individuals. Both are now recognized as originating from electrical disturbances in the brain, although their wider manifestations involve the recruitment of multiple pathogenic mechanisms. An initial excess of neuronal activity in migraine leads to cortical spreading depression and aura, with the subsequent recruitment of the trigeminal nucleus leading to central sensitization and pain. In epilepsy, neuronal overactivity leads to the recruitment of larger populations of neurons firing in a rhythmic manner that constitutes an epileptic seizure. Migraine aura and headaches may act as a trigger for epileptic seizures. Epilepsy is not infrequently accompanied by preictal, ictal, and postictal headaches that often have migrainous features. Genetic links are also apparent between the two disorders, and are particularly evident in the familial hemiplegic migraine syndromes where different mutations can produce either migraine, epilepsy, or both. Also, various medications are found to be effective for both migraine and epilepsy, again pointing to a commonality and overlap between the two disorders. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 45-year-old woman who had a history of seizures with episodic migraine and migralepsy. It notes that the attacks were caused by stressful circumstances and odour. The article discusses the treatment for the attacks which includes the use of sumatriptan and benzodiazepine.

Ictal headaches are increasingly becoming the focus of research as more data demonstrate headaches existing as a sole manifestation of an epileptic event. Due to the difficulty in diagnosing the event as an epileptic phenomenon as opposed to a migraine, the condition is often misdiagnosed. This paper seeks to review the current published literature on ictal epileptic headaches as well as provide differentiation between ictal headaches and similarly presenting conditions. In doing so, we hope to improve the diagnosis of ictal headaches and thus improve patient care. We review two case studies that exemplify the potential of multiple conditions with comparable symptoms to ictal headaches, and discuss how to differentiate the variable diagnoses. As of the writing of this paper, there is no universally agreed upon set of features of ictal headaches; however, reviewing the current literature, there do seem to be several features that should be noted when treating patients. More research on the pathophysiology of ictal epileptic headaches needs to be done before the condition can be fully understood. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: There are different possible temporal associations between epileptic seizures and headache attacks which have given rise to unclear or controversial terminologies. The classification of the International League Against Epilepsy does not refer to this type of disorder, while the International Classification of Headache Disorders (ICHD-2) defines three kinds of association: 1. migraine-triggered seizure (“migralepsy”), 2. hemicrania epileptica, and 3. post-ictal headache. Methods: We performed an extensive review of the literature, not including “post-ictal” and “inter-ictal” headaches. Results: On the basis of well-documented reports, the following clinical entities may be identified: (A) “epileptic headache (EH)” or “ictal epileptic headache (IEH)”: in this condition headache (with or without migrainous features) is an epileptic manifestation per se, with onset, and cessation if isolated, coinciding with the scalp or deep EEG pattern of an epileptic seizure. EH maybe followed by other epileptic manifestations (motor/sensory/autonomic); this condition should be differentiated from “pure” or “isolated” EH, in which headache/migraine is the sole epileptic manifestation (requiring differential diagnosis from other headache forms). “Hemicrania epileptica” (if confirmed) is a very rare variant of EH, characterized by ipsilateral location of headache and ictal EEG paroxysms. (B) “Pre-ictal migraine” and “pre-ictal headache”: when a headache attack is followed during, or shortly after, by a typical epileptic seizure. The migraine attack may be with or without aura, and its seizure-triggering role (“migraine-triggered seizure”) is still a subject of debate. A differentiation from occipital epilepsy is mandatory. The term “migralepsy” has not been used uniformly, and may therefore led to misinterpretation. Conclusions: On the basis of this review we suggest definitions and a terminology which may become the basis of a forthcoming classification of headaches associated with epileptic seizures. [Copyright &y& Elsevier]

Headache and epilepsy often co-occur. Epidemiologic studies conducted in the past few years reinforce the notion of a bi-directional association between migraine and epilepsy. Data on an association between headache (in general) and epilepsy, however, are less clear. Peri-ictal headache often presents with migraine-like symptoms and can be severe. A correct diagnosis and management are paramount. It was demonstrated that cortical hyperexcitability may underlie both epilepsy and migraine. A recent study linked spreading depolarisation, the supposed underlying pathophysiological mechanism of migraine with aura, to epilepsy. Although this study was carried out in patients who had suffered a subarachnoid haemorrhage, the finding may shed light on pathophysiological mechanisms common to epilepsy and migraine. [ABSTRACT FROM AUTHOR]

Abstract: The relationship between headache and seizures is a complicated one, since these two conditions are related in numerous ways. Although the nature of this association is unclear, several plausible explanations exist: the two disorders coexist by chance; headache is part (or even the sole ictal phenomenon) of seizures or the post-ictal state; both disorders share a common underlying etiology; and epilepsy mimics the symptoms of migraine (as in benign childhood epilepsy). Seizures and headaches as well as their respective primary syndromes (epilepsy and headache/migraine) share several pathophysiological mechanisms. These mechanisms especially involve neurotransmitter and ion channel dysfunctions. Also, photosensitivity seems to play a role in the connection. In order to improve the care for patients with a clinical connection between migraine and epilepsy, it is necessary to try to understand more accurately the exact pathophysiological point of connection between these two conditions. Both experimental and clinical measures are required to better understand this relationship. The development of animal models, molecular studies defining more precise genotype/phenotype correlations, and multicenter clinical studies with revision of clinical criteria for headache/epilepsy-related disorders represent the start for planning future translational research. In this paper, we review the relationship between migraine and epilepsy in terms of epidemiology and pathophysiology with regard to translational research and clinical correlations and classification. This article is part of a Special Issue entitled “The Future of Translational Epilepsy Research”. [Copyright &y& Elsevier]

Gowers gave migraine a place in the borderland of epilepsy, justified by many relations and the fact that distinction of these two diseases is difficult. Gowers based his ideas on clinical histories from his patients, and he concluded that in extremely rare instances one may develop while the other goes on. In modern times, patient testimonies of the problem of differentiating migraine from epilepsy are given in health-chat Websites. It shows clearly that distinction between the two conditions is still problematic and that migralepsy is either nonexisting or extremely rare as Gowers noticed. [ABSTRACT FROM AUTHOR]

Despite the fact that migraine and epilepsy are among the commoner brain diseases and that comorbidity of these conditions is well known, only few reports of migralepsy and hemicrania epileptica (HE) have been published according to the current ICHD-II criteria. Particularly, ICHD-II describes 'migraine-triggered seizure' (i.e., migralepsy) among complications of migraine at '1.5.5' (as a rare event in which a seizure happens during migrainous aura), while hemicrania epileptica (coded at '7.6.1') and post-ictal headache (coded at '7.6.2') are described among headaches attributed to epileptic seizure. However, to date neither the International Headache Society nor the International League against Epilepsy mention that headache/migraine may be the sole ictal epileptic manifestation. Based on the current knowledge, migralepsy is highly unlikely to exist as such. We, therefore, propose to delete this term until clear evidence its existence is provided. Moreover, we herein propose a revision of terminology and classification criteria to properly represent the migraine/headache relationships. We suggest the term 'ictal epileptic headache' in cases in which headache/migraine is the sole ictal epileptic manifestation. [ABSTRACT FROM AUTHOR]

Abstract: The few reports that have been published on the current International Classification of Headache Disorders, Second Edition (ICHD-II), criteria for migralepsy and hemicrania epileptica have highlighted the considerable confusion regarding this “hot topic” within both headache and epilepsy classifications (ICHD-II and International League Against Epilepsy [ILAE]). Indeed, the ICHD-II describes a migraine-triggered seizure as a rare event in which a seizure occurs during migraine aura; on the other hand, hemicrania epileptica is described as an “ictal headache” that occurs “synchronously” with a partial seizure. To confuse matters even further, neither the term migralepsy nor the term hemicrania epileptica is included in the currently used ILAE classification. On the basis of both a review of “migralepsy” cases in the literature and 16 additional retrospective multicenter cases, we suggest that the term migraine-triggered seizure or migralepsy be deleted from the ICHD-II classification until unequivocal evidence is provided of its existence, and that the term ictal epileptic headache be introduced into the ILAE classification. [Copyright &y& Elsevier]

Abstract: Basic and clinical neuroscience research findings suggest that cortical spreading depression (CSD) and epileptic foci may facilitate each other; furthermore, the threshold required for the onset of CSD has been suggested to be lower than that required for an epileptic focus. These data may explain the prevalence of epilepsy in migraine populations (ranging from 1% to 17%) and the frequency of migraine in epileptic populations (ranging from 8.4% to 20%). There is currently a considerable amount of confusion regarding this topic in both headache and epilepsy classifications (ICHD-II and ILAE). The ICHD-II includes “migraine-triggered seizure” (coded as “1.5.5”) (so-called “migralepsy”) among the “complications of migraine”, and defines “hemicrania epileptica” (“7.6.1”) as an “ictal headache” (ipsilateral to the ictal EEG discharge) that occurs “synchronously” with a seizure (partial epileptic seizure) recognized by ILAE classification. However, neither “migralepsy” nor “hemicrania epileptica” are terms used in the current ILAE classification. On the basis of data reported in the literature and our recent findings, we suggest that the terms “migraine-triggered seizure” and “migralepsy” be deleted until unequivocal evidence of the existence of these conditions emerges. “Ictal epileptic headache” (IEH) should be used to classify those rare events in which headache represents the sole ictal epileptic manifestation. On the other hand, the term “hemicrania epileptica” should be maintained in the ICHD-II and introduced into the ILAE, and be used to classify all cases in which an “ictal epileptic headache” “coexists” and is associated synchronously or sequentially with other ictal sensory-motor events. [Copyright &y& Elsevier]

lthough headache and epilepsy have often been associated, the precise electroclinical and pathophysiological interaction between these disorders and in particular its relations with photosensitivity is as yet to be fully understood in adults or children. The association between headache and epilepsy commonly occurs in all types of epilepsy and not only in occipital epilepsy. Generally, peri-ictal headache is often neglected, regardless of its severity, because patients are more concerned about their seizures. Altered cerebral cortex excitability may be the link between these two conditions and photosensitivity shows this. The physician should bear this association in mind when dealing with epileptic and migraine patients so as to be able to offer such patients an accurate diagnosis and appropriate treatment; this should be borne in mind when declaring epileptic patients 'seizure free'. To date neither the International Headache Society nor the International League against Epilepsy mention that headache/migraine may, on occasion, be the sole ictal epileptic manifestation. Lastly, studies designed to investigate the triggering role of photosensitivity in both headache and epilepsy are warranted. [ABSTRACT FROM AUTHOR]

Migralepsy is an ill-defined nosologic entity, with only a few cases described in the literature. In the 2004 International Classification for Headache Disorders (ICHD-II), the International Headache Society proposed that the following diagnostic criteria should be met: (1) migraine fulfilling criteria for 1.2 Migraine with aura (MA) and (2) a seizure fulfilling diagnostic criteria for one type of epileptic attack occurs during or within 1 h after a migraine aura. Herein, by presenting a case with symptoms suggestive of migralepsy and by reviewing all previous cases described in the literature, we discuss the challenges of differentiating this condition from epileptic seizures, as well as the inaccuracy of the current ICHD-II definition. [ABSTRACT FROM AUTHOR]

The relationship between epilepsy and migraine is complex and remains to be determined. We report 3 cases that address 2 questions on this topic. The first and second cases showed an association between migraine without aura and the onset of epileptic seizures. The third case report describes a patient in whom migraine with aura occurred and was followed by the development of status epilepticus, which occurred 2 or 3 hours after the attack of migraine with aura. We discuss the present definition of migralepsy and reassess its definition by suggesting possible extensions to its current definition. [ABSTRACT FROM AUTHOR]

The term “migralepsy” indicates a particular condition in which seizures occur during a migraine attack. Several cases of seizures associated with migraine with aura and characterized by transient MRI abnormalities have been published. We report the case of a patient who presented 2 generalized seizures during an attack of migraine without aura and with a transient, diffuse, irregular, high voltage slow activity without clear epileptiform abnormalities in subsequent EEG recordings. [ABSTRACT FROM AUTHOR]

Migraine and epilepsy are both chronic disorders characterized by recurrent neurologic attacks variously accompanied by headache as well as by gastrointestinal, autonomic, and psychologic features. Migraine and epilepsy are linked by their symptom profiles, comorbidity, and treatment. The presence of one disorder increases the likelihood that the other is also present. In addition, a number of migraine syndromes can be confused with epilepsy. The diagnosis and treatment of each disorder must take into account the potential presence of the other. Herein, we review the relationship between migraine and epilepsy. We discuss the diagnosis of migraine using the International Headache Society criteria, emphasizing the variants of migraine most frequently mistaken for epilepsy. We summarize the epidemiologic evidence that migraine and epilepsy are associated and discuss specific interrelationships between migraine and epilepsy. [Copyright &y& Elsevier]

The complex relationship between migraine and epilepsy is highlighted by the occurrence of a seizure during a migraine attack without aura. This phenomenon, referred to as migralepsy, suggests an inherent overlap in the underlying pathophysiology of these events. We report the case of a patient who had a generalized seizure, persistent nondominant hemisphere syndrome, and reversible magnetic resonance imaging abnormalities during a prolonged migraine attack without aura. [ABSTRACT FROM AUTHOR]

In the last few years several cases of headache as sole manifestation of an epileptic seizure have been reported and the term 'ictal epileptic headache' has been recently proposed to identify an EEG-recorded epileptic seizure with migraine/headache-like features. Among the potential practical implications arising from these clinical observations, there is the urgent need for a revision of both International Classifications of Epilepsy and Headache disorders. We discuss these topics and provide additional comments about the physiopathological links between epilepsy and migraine. [ABSTRACT FROM AUTHOR]