Migraine-like Symptoms Triggered by Occipital Lobe Seizures: Response to Sumatriptan

Abstract

Background: The relationship of ictal and post-ictal cephalic pain to migraine remains debatable. We hereby report 2 patients whose post-ictal migraine-like symptoms ameliorated in response to oral sumatriptan. Methods: Two patients, a 27-year-old woman and 41-year-old man were referred for assessment of migraine of 10 years and 4 years duration, respectively. The man described a recent episode of "vacant stare" and the woman has sensitivity to bright colours and light. Neurological examination, visual field testing, CAT scan, MRI scan, and prolonged EEC recordings were accomplished for each patient. Results: The man had a spontaneous seizure with ictal discharge arising from the right occipital lobe. Bilateral occipital spikes, associated with palinopsia was triggered in the woman by photic stimulation. Both patients developed post-ictal headaches with symptoms similar to their migraines. The symptoms subsided following treatment with oral sumatriptan. Conclusion: Migraine-like symptoms occurring following occipital lobe seizures may share similar pathophysiological substrates with idiopathic migraine. Serotonergic mechanisms may be implicated.