Abstracts

Rationale: Migraine and Epilepsy share many clinical features, in fact a positive family history of migraine is not uncommon among pediatric patients with epilepsy and vise versa. Striking EEG patterns have been described in specific subtypes of migraine as in migraine with aura, basilar and hemiplegic migraine.Moreover some antiepileptic drugs proved to be efficient in migraine prophylaxis. The study aimed at identifying the incidence of epilepsy among cases referred with headache as a sole complaint and fulfilling the criteria for diagnosis of “pediatric migraine without an aura”. Methods: All cases referred to the Pediatric neurology clinic with headache and who were fulfilling the criteria for diagnosis of “pediatric migraine without an aura” during a 24 months period from May 2006 to May 2008 were enrolled in the study. Each patient was subjected to full history taking including headache diary, precipitants of the attacks, positive family history of migraine or epilepsy, thorough systemic and neurological examination, awake and sleep EEG recording as well as Brain MRI when indicated. Results: Fourty seven patients were referred because of headache as the sole complaint, twenty one patients satisfied the inclusion criteria, their ages ranged from four to eleven years, male to female ratio was 1: 1.2, headache was associated with nausea and or vomiting in seven patients and was associated with photophobia in five. All the twenty one patients had unremarkable neurological examination, one patient was underweight and proved to have a craniopharyngioma on brain imaging; his EEG was unremarkable. Eight patients had abnormal EEG, three had predominantly occipital spikes +/- generalization, two of whom also showed fixation off sensitivity, they were diagnosed as Panayiotopoulos syndrome, one patient had photoconvulsive response to photic stimulation, a twin were having photic and pattern sensitivity as well as abcences, one patient had centro-temporal spikes augmented during sleep and one had fronto-central discharges augmented during sleep. All patients with abnormal EEG were free of headache attacks on follow up after start of antiepileptic medication, which was sodium valproate in four, topiramate in two and levetiracetam in two. Conclusions: The results of this work emphasize the concept that “criteria for diagnosis of Pediatric migraine without an aura” are not specific, overlap in the clinical presentation between epileptic syndromes, mainly the idiopathic types, and migraine is common in the pediatric age group, especially in children below the age of eight years. It is crucial to highlight that a slowly growing space occupying lesion as craniopharingioma may only present with a subtle picture of migraine headache in the presence of unremarkable neurological examination. Criteria to differentiate between migraine without aura and epilepsy in the pediatric age group need to be identified, what EEG changes can be accepted as common EEG abnormalities in migraine and which deserve antiepileptic treatment and for how long, questions that still need to be clarified.