Abstracts

Rationale: The comorbidity between migraine and epilepsy has been known since one century ago, yet is not understood in full. Migraine and epilepsy share some risk factors, positive and negative symptoms, and preventive drug therapy. Headache, in relation to visual stimuli as a pure autonomic epileptic manifestation, is underestimated. Methods: To examine the link between migraine and epilepsy we prospectively evaluated selected families, in which both headache and photosensitivity were reported to the (child) neurologists of the university hospital in Rome between 2005-2006. The proband and all first degree family members were invited for EEG investigation. Those who gave consent were investigated with standardized photic stimulation and striped pattern stimulation. Four families, of whom two were multi-generational, have been selected and investigated. Results: Twelve of the total 25 family members have a history of headache; five of them had epilepsy. A PPR was found in the EEG of 8 of the 25 members often in relation with headache complaints. In addition, a visually induced autonomic seizure was registered with headache as the only complaint. In our cases, the clinical overlap between migraine and epilepsy is complete and headache might even represent the sole autonomic manifestation of an epileptic condition. Conclusions: We advocate performing an EEG with standardised Intermittent Photic Stimulation (IPS) in all headache patients having family members with epilepsy. This has consequences for treatment.