Should “migralepsy” be considered an obsolete concept? A multicenter retrospective clinical/EEG study and review of the literature

Verrotti, Alberto; Coppola, Giangennaro; Fonzo, Alessia Di; Tozzi, E.; Spalice, Alberto; Aloisi, Paolo; Bruschi, Raffaella; Iannetti, Paola; Villa, Maria Pia; Parisi, Pasquale

doi:10.1016/j.yebeh.2011.03.004

Cited by 67 publications

(88 citation statements)

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“…However, when headache and epilepsy overlap as a result of the crossing of the cascade of events at the cortical level, in both of the events (CSD and epileptic focus), their onset and propagation are triggered when these events reach a certain threshold, which is lower for CSD than for seizure [6][7][8][9][10][11][12]. These two phenomena may be triggered by more than one pathway converging (at cortical level) upon the same destination: depolarization and hypersynchronization.…”

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confidence: 99%

“…Recently, we have studied this aspect in depth and, due to lack of space, here we refer to the recently published [6][7][8][9][10][11][12]. In this respect, we consider of particular interest the patients reported by Fabricius et al, "…whose seizure activity spread from electrode to electrode at the same slow speed as CSD…" [13].…”

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“…With regards to the epidemiological literature findings on comorbidity between headache and epilepsy, the major discrepancies and conflicting data are due to: the confusion and mixture of epidemiological data between adults and children across studies, and the significant underestimation of headache when it is comorbid in populations with epilepsy; in addition, it is likely that the comorbidity is higher in children than in adults, as is the case for all other ictal autonomic manifestations [10][11][12]14]. Indeed, the conflicting literature data on this topic can be explained by the co-occurrence (synergistic and/or divergent) of confounding variables according to the different sampling and study design.…”

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“…In this regard, we have recently suggested to include 'ictal headache' among the ictal autonomic manifestations in both headache and epilepsy international classifications, which until now have always ignored each other [1,[6][7][8][10][11][12]16]. In particular, we have proposed new criteria for the event termed 'ictal epileptic headache' (IEH) in which "headache is the sole ictal epileptic manifestation" [1,2].…”

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“…According to our recently proposed criteria [2] for IEH, there are serious doubts about the real existence of the phenomenon called 'migralepsy' [1,10,15]. Recent scientific evidences on the ictal epileptic headache' have convinced us that the 'migralepsy' concept is exceptional or even it does not exist.…”

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confidence: 99%

Section: For Reprint Orders Please Contact Reprints@expert-reviewscommentioning

confidence: 99%

Section: For Reprint Orders Please Contact Reprints@expert-reviewscommentioning

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Section: For Reprint Orders Please Contact Reprints@expert-reviewscommentioning

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Key Points-Headache/migraine is often associated with epilepsy in children, as a pre-ictal, ictal, post-ictal or inter-ictal phenomenon.-Epidemiological aspects of the co-morbidity between epilepsy and headache are clearly different in children and adults.-Headache as a symptom, with migraine characteristics and/or tension-type headache characteristics, may be the only clinical ictal manifestation of an epileptic seizure: this condition is now classified as "ictal epileptic headache".-In particular, according to published criteria, the term "ictal epileptic headache" must be used in cases of a headache/migraine attack as the sole clinical ictal symptom of epileptic origin, confirmed by ictal-EEG recording and clinical-EEG responsiveness to intravenous antiepileptic drugs.-EEG is not recommended as a routine examination for children diagnosed with headache, but is mandatory and must be carried out promptly in cases of prolonged migraine/headache that does not respond to antimigraine drugs and in which epilepsy is suspected.-This is not a marginal question, because these possible, isolated, non-motor, ictal manifestations (i.e. ictal epileptic headache) should be taken into account before declaring an epileptic patient as "seizure free" so as to be able to suspend anticonvulsant therapy safely. SummaryThe possible link/comorbidity (causal or not causal) between epilepsy and headaches has been a topic of debate for over a hundred years, ever Since William Richard Gowers's time. In recent decades, new data have emerged in favor of a non-random relationship between these two entities. They are both characterized by transient attacks of altered brain function with a clinical, pathophysiological, genetic and therapeutic overlap, and may thus mimic each other. Indeed, the clinical distinction between headache and epilepsy may make the differential diagnosis a highly challenging task. Both are common and often co-morbid, with headache attacks in epilepsy being temporally related to the occurrence of epileptic seizures as a pre-ictal, ictal, post-ictal or inter-ictal event. Yet, they are both paroxysmal and chronic neurological disorders that share many clinical and epidemiological aspects, and they may both present with visual, cognitive, sensitive-sensorial and motor signs/symptoms; these neurophysiologicl phenomena arise from the cerebral cortex and are modulated by sub-cortical connections. Even from an epidemiological point of view, data in the literature regarding the co-morbidity between headache and epilepsy appear to be quite distinct in children. What makes this scenario even more variegated and complex are new data suggesting that a headache may, in some cases, even be the only ictal manifestation of an epileptic seizure. The latter condition, the so-called "ictal epileptic headache", is a new entity that has recently been cited in the new classification of headache disorders (ICHD-III), whose diagnostic criteria have very recently been defined and published. The data that have led, over the last decade, to the...

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Should “migralepsy” be considered an obsolete concept? A multicenter retrospective clinical/EEG study and review of the literature

Cited by 67 publications

References 40 publications

The crossover between headache and epilepsy

The crossover between headache and epilepsy

Neurologic and Psychiatric Comorbidities in Pediatric Headache Patients

The Complex Relationship Between Epilepsy and Headache and the Concept of Ictal Epileptic Headache

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