Migraine and epilepsy frontiers, new challenges in its understanding: A case report

• Over half a century later, several authors still argue that migraine and epilepsy are completely different disorders. • The exact pathophysiological bases that migraine and epilepsy share are unknown. • The international classification of headache disorders does not include patients with migraine without aura within the migraine triggered seizure criteria, making their stratification in formal classifications impossible. • A case of atypical presentation is reported in which the synergistic relationship between epilepsy and migraine is evident, new challenges. The relationship between migraine and epilepsy has been recognized since the 20th century. Currently, both pathologies share several characteristics, from molecular and electrophysiological mechanisms to their similarity in clinical symptoms and response to treatment. This is a case report of an 11-year-old male patient who presented with focal epilepsy at the age of 8 years. One year later, he developed episodes of migraine without aura followed by seizures with a frequency of 1–2 times per month, with headache duration ranging from 10 min to 6 h. At age 11, he also presented other episodes in which the headache occurred after the epileptic event and other episodes in which the headache was present both before and after the epileptic seizure. An interictal EEG study and an EEG study during a migraine attack showed the presence of high-voltage theta activity and bilateral temporo-parieto-occipital spikes with a greater expression in the right cerebral hemisphere. To our knowledge, this is the first report of an atypical presentation of migraine without aura and epileptic seizure. This case opens new challenges in the search for understanding between both pathologies.