Why is migraine rarely, and not usually, the sole ictal epileptic manifestation?

  • Parisi P
  • Hadjikhani N
  • Rio M
 et al. 
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PURPOSE AND METHODS: 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. RESULTS AND CONCLUSION: 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.

Author-supplied keywords

  • CSD
  • Cerebrovascular Circulation
  • Cerebrovascular Circulation: physiology
  • Cortical Spreading Depression
  • Cortical Spreading Depression: physiology
  • Cortical spreading depression
  • Electroencephalography
  • Epilepsy
  • Epilepsy: complications
  • Epilepsy: diagnosis
  • Hemicrania epileptica
  • Humans
  • Ictal epileptic headache
  • Migraine
  • Migraine Disorders
  • Migraine Disorders: complications
  • Migraine Disorders: diagnosis
  • Models
  • Neurological
  • Photic Stimulation
  • Trigeminal Nerve
  • Trigeminal Nerve: physiopathology
  • Trigemino-vascular theory

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  • Pasquale Parisi

  • N. Hadjikhani

  • M. Sanchez del Sánchez del Rio

  • O. Wu

  • D. Schwartz

  • D. Bakker

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