• Pasquale Parisi.
• Child Neurology and Pediatric Headache Centre, Department of Pediatrics, La Sapienza University, Viale Regina Elena 324, 00161 Rome, Italy. pasquale.parisi@uniroma1.it.
• Seizure. 2009 Jun 1;18(5):309-12.

Purpose And MethodsMigraine, 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 ConclusionThe 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.

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