Migraine Headache

Understanding Migraine Epilepsy Syndromes

Syndromes are clinical conditions in which some clinically recognizable features observed in two different medical situations are observed together. Something similar happens in the case of migraine. In certain cases of migraine, clinical symptoms similar to epilepsy are seen. These are eventually called migraine-epilepsy syndromes.

Migraine-epilepsy syndromes are essentially of two types:

* Benign rolandic epilepsy
* Benign occipital epilepsy of childhood with occipital paroxysms

Benign Rolandic Epilepsy
Benign rolandic epilepsy is characterized by centrotemporal spikes and unilateral somatosensory (or motor seizures). Pooling of saliva, speech arrest, and usually, preservation of consciousness are typical symptoms of benign rolandic epilepsy. At the same time, side to side shift is also seen in clinical and electrographic features.

The prevalence of migraine was observed in patients with absence of epilepsy (34%), in cases of centrotemporal epilepsy (62%), in cases of partial epilepsy (8%) and in cases of nonepileptic patients with a history of cranial trauma (6%). As the figures suggest, migraine is not a uniformly recurring part of these epileptic attacks.

Treatment of benign rolandic epilepsy is administered successfully through anticonvulsant medication. Usually, benign rolandic epilepsy ceases by the age of 15 and there is no need to further administer medication.

Benign Occipital Epilepsy of childhood with occipital paroxysms
In this clinical syndrome, epileptic patients are seen to first suffer from visual symptoms and subsequently from partial seizures and postictal migraine. Out of the two, it is Benign Occipital Epilepsy that has the features of both- migraine and epilepsy.

The seizures begin with visual symptoms such as amaurosis, elementary visual hallucinations (phosphenes), and complex visual hallucinations that include metamorphopsia, micropsia, or palinopsia. Once the seizures are over, up to 40 per cent patients develop migraine-like headaches.

Distinct occipital discharges and normal background activity is usually observed in the interictal EEG. The occipital spikes typically have a high voltage (200-300 mV), a bilateral or unilateral occipital and posterotemporal distribution, and diphasic morphology. Once the patient opens his/her eyes, these spikes tend to disappear. However, they tend to reappear after 1 to 20 seconds of eye closure.

In a study of 53 patients suffering from BOEP, it was observed that only 55 per cent exhibited the complete syndrome of ictal visual symptoms, occipital spikes followed by a partial seizure, and migraine. Migraine was not seen in cases of nocturnal seizures (in which motor seizures predominated), and diurnal seizures (in which visual symptoms were more common).

People who are suffering from migraine are also seen to exhibit symptoms related to epilepsy. Occipital spikes are an example of the observable symptoms. To treat these syndromes, it is best that a thorough diagnosis from a physician/neurologist is followed by the recommended medication. In many cases, time might help individuals get rid of these syndromes. However, till that happens it is best to take care of the syndromes through medication.