Why is migraine rarely, and not usually, the sole ictal epileptic manifestation?
OBJECTIVE
Migraine, with or without aura, affects from 10% to 14% of the population, and is as such one of the most common headache disorders. A unified hypothesis for the physiopathology of migraine and its relationship with epileptic migraine and migralepsy has yet to be formulated. Trigemino-vascular system (TVS) activation is believed to play a crucial role in the "pain phase" in migraine; cortical spreading depression (CSD) is considered to be the primary cause of TVS activation. On the basis of data in the literature, I would like to stress that TVS activation may originate at different cortical and subcortical levels. For example, as recently reported, an epileptic focus, originating and propagating along cortical non-eloquent/silent areas, through CSD, rarely causes TVS activation with migraine as the sole ictal epileptic manifestation.


CONCLUSIONS
The multiple considerations that arise from this hypothesis, including the under-diagnosed ictal epileptic headache, are discussed; EEG (ictal and inter-ictal) recording with intermittent photic stimulation (IPS), according to the standardized international protocol, is strongly recommended in selected migraine populations.
Parisi
Pasquale
P
Child Neurology and Pediatric Headache Centre, Department of Pediatrics, La Sapienza University, Viale Regina Elena 324, 00161 Rome, Italy. pasquale.parisi@uniroma1.it.
D002560:Cerebrovascular Circulation / Q000502:physiology; D013181:Cortical Spreading Depression / Q000502:physiology*; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008881:Migraine Disorders / Q000150:complications / Q000175:diagnosis*; D008959:Models, Neurological; D010775:Photic Stimulation; D014276:Trigeminal Nerve / Q000503:physiopathology