Table 1

Migraine variants that can potentially be misdiagnosed as epilepsy (diagnostic criteria for each condition are described in the International Headache Society Classification (ICHD-II) website:

Migraine syndromeComments
Migraine with aura
  • An aura is a transient subjective feeling of unusual visual symptoms, abnormal sensations (numbness or ‘pins and needles’) or speech disturbance that typically precedes onset of headache

  • Aura symptoms are described in up to one-third of childhood migraine

  • Onset is gradual over 5–20 min (as opposed to seizures) and lasts <60 min

  • Abrupt onset of visual aura may indicate occipital lobe epilepsy

Typical aura without headache (acephalgic migraine)
  • Typical aura with non-migraine headache is also described

Hemiplegic migraine
  • Either familial or sporadic

  • Typical presentation is with stroke-like hemiparesis with a migrainous-type headache

  • Clinically evident weakness must be demonstrated

  • May be confused with Todd's (postictal) paresis

Acute confusional migraine
  • Attack is marked with abrupt onset of agitation, disorientation and behavioural changes

  • Confusion lasts from minutes to hours

  • There may be no recollection of the event and the associated headache

  • A diagnosis of exclusion

‘Alice in Wonderland’ syndrome
  • A form of migraine with atypical visual aura

  • Abnormal visual illusions with spatial distortions

  • The differential diagnosis includes occipital lobe epilepsies

Retinal migraine
  • Episodic reversible monocular visual disturbance associated with ipsilateral retro-orbital pain

Basilar-type migraine
  • Symptoms (and signs) of brainstem or posterior fossa involvement

  • Attacks of dizziness, vertigo, ataxia, dysarthria and diplopia for minutes or up to an hour followed by the headache phase

  • May be associated with decreased level of consciousness

  • The combination of the above features may be confused with complex focal seizures