title: Patients with psychogenic nonepileptic seizures report more severe migraine than patients with epilepsy.
abstract: OBJECTIVE
  Clinical observations suggest that psychogenic non-epileptic seizure (PNES) patients often have severe migraine, more severe than epilepsy patients. Investigations into migraine characteristics in patients with PNES are lacking. In this study we tested the hypothesis that, compared to epilepsy patients, PNES patients have more severe migraine, with more frequent and longer duration attacks that cause greater disability.
  
  
  METHODS
  In this observational study, 633 patients with video-EEG proven epilepsy or PNES were identified from the Mayo Clinic Epilepsy Monitoring Unit database. Contacted patients were screened for migraine via a validated questionnaire, and when present, data regarding migraine characteristics were collected. Two-sample t-tests, chi square analyses, and Mann-Whitney U tests were used to compare migraine characteristics in PNES patients to those of epilepsy patients.
  
  
  RESULTS
  Data from 43 PNES patients with migraine and 29 epilepsy patients with migraine were available. Compared to epilepsy patients, PNES patients reported having more frequent headaches (mean 15.1 ± 9.8 vs. 8.1 ± 6.6 headache days/month, p<.001), more frequent migraine attacks (mean 6.5 ± 6.3 vs. 3.8. ± 4.1 migraines/month, p=.028), longer duration migraines (mean 39.5 ± 28.3 vs. 27.3 ± 20.1h, p=.035), and more frequently had non-visual migraine auras (78.6% vs. 46.7% of patients with migraine auras, p=.033). Migraine-related disability scores were not different between PNES and epilepsy patients (median 39, interquartile range 89 vs. 25, interquartile range 60.6, p=.15).
  
  
  CONCLUSIONS
  Compared to epilepsy patients with migraine, PNES patients with migraine report having a more severe form of migraine with more frequent and longer duration attacks that are more commonly associated with non-visual migraine auras.
authors.affiliation: Mayo Clinic, AZ, United States.
authors.forename: Morgan A
authors.initials: MA
authors.lastname: Shepard
authors.affiliation: Mayo Clinic, AZ, United States.
authors.forename: Annelise
authors.initials: A
authors.lastname: Silva
authors.affiliation: Mayo Clinic, AZ, United States.
authors.forename: Amaal J
authors.initials: AJ
authors.lastname: Starling
authors.affiliation: Mayo Clinic, AZ, United States.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Hoerth
authors.affiliation: Mayo Clinic, AZ, United States.
authors.forename: Dona E C
authors.initials: DE
authors.lastname: Locke
authors.affiliation: Florida Center for Neurology, United States.
authors.forename: Kristine
authors.initials: K
authors.lastname: Ziemba
authors.affiliation: Mayo Clinic, AZ, United States.
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Chong
authors.affiliation: Mayo Clinic, AZ, United States. Electronic address: Schwedt.todd@mayo.edu.
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Schwedt
mesh_terms: D000328:Adult; D003291:Conversion Disorder / Q000150:complications*; D004827:Epilepsy / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications* / Q000453:epidemiology*
keywords: Epilepsy; Headache; Migraine; Pseudoseizures; Psychogenic non-epileptic seizures