Should “migralepsy” be considered an obsolete concept? A multicenter retrospective clinical/EEG study and review of the literature Alberto Verrotti a , Giangennaro Coppola b , Alessia Di Fonzo a , Elisabetta Tozzi c , Alberto Spalice d , Paolo Aloisi c , Raffaella Bruschi e , Paola Iannetti d , Maria Pia Villa e , Pasquale Parisi e, ⁎ a Child Neurology and Department of Pediatrics, University of Chieti, Chieti, Italy b Child Neuropsychiatry, University of Naples, Naples, Italy c Child Neuropsychiatry, University of L'Aquila, L'Aquila, Italy d Child Neurology, Chair of Pediatrics, First Faculty of Medicine, Sapienza University, Rome, Italy e Child Neurology, Pediatric Headache Centre, Sleep Disorders Centre, Second Faculty of Medicine, Sapienza University, Rome, Italy abstract article info Article history: Received 12 January 2011 Revised 28 February 2011 Accepted 4 March 2011 Available online 15 April 2011 Keywords: Peri-ictal headache Postictal headache Ictal epileptic headache Migraine Epilepsy Migralepsy Hemicrania epileptica Status migrainosus Status epilepticus Epilepsy The few reports that have been published on the current International Classification of Headache Disorders, Second Edition (ICHD-II), criteria for migralepsy and hemicrania epileptica have highlighted the considerable confusion regarding this “hot topic” within both headache and epilepsy classifications (ICHD-II and International League Against Epilepsy [ILAE]). Indeed, the ICHD-II describes a migraine-triggered seizure as a rare event in which a seizure occurs during migraine aura; on the other hand, hemicrania epileptica is described as an “ictal headache” that occurs “synchronously” with a partial seizure. To confuse matters even further, neither the term migralepsy nor the term hemicrania epileptica is included in the currently used ILAE classification. On the basis of both a review of “migralepsy” cases in the literature and 16 additional retrospective multicenter cases, we suggest that the term migraine-triggered seizure or migralepsy be deleted from the ICHD-II classification until unequivocal evidence is provided of its existence, and that the term ictal epileptic headache be introduced into the ILAE classification. © 2011 Elsevier Inc. All rights reserved. 1. Introduction Although not fully elucidated, a relationship between migraine and epilepsy has long been postulated, with clinical and epidemio- logical studies demonstrating that both entities are highly comorbid [1–12]. As both these disorders are characterized by transient paroxysmal episodes of altered brain function, one condition may be mistaken for the other [1–12]. Epilepsy and migraine may either coexist independently in the same individual or be associated by chance; the outcome of this comorbidity is that one of these disorders may lead to, or mimic, the other. Although the nature of this association is unclear, several plausible explanations do exist, including: the two disorders coexist by chance; headache is part (or even the sole ictal phenomenon) of seizures or the postictal state; both disorders share a common underlying etiology; epilepsy mimics the symptoms of migraine (as in benign childhood epilepsy); lastly, migraine with aura triggers seizures, a phenomenon referred to as migralepsy [1]. Recently, Parisi et al. [13–22] suggested that the term ictal epileptic headache be used for patients whose headache rarely represents the sole ictal epileptic manifestation; on the basis of articles and cases previously published by both their group [13–22] and other groups [2,23–34], they suggested that the “migralepsy concept” might not exist at all, and that headache is simply the first ictal epileptic symptom in most “migralepsy” cases [13–22]. In other words, “migralepsy” probably represents an epileptic event that starts with an “ictal epileptic headache” followed by other sensory/motor/autonomic ictal epileptic signs/symptoms. Nonetheless, the term migralepsy (“migraine-triggered seizure”) is currently included in the International Classification of Headache Disorders, Second Edition (ICHD-II); its use is based on the fulfillment of two criteria: (1) migraine fulfilling criteria for 1.2 Migraine with aura (MA); (2) a seizure fulfilling the International League Against Epilepsy (ILAE) classification diagnostic criteria for one type of epileptic attack occurring within 1 hour of a migraine aura. Epilepsy & Behavior 21 (2011) 52–59 ⁎ Corresponding author at: Child Neurology, Headache Paediatric Center, Paediatric Sleep Disorders, II Faculty of Medicine, Sapienza University, c/o Sant'Andrea Hospital, Via di Grottarossa, 1035–1039, Rome, Italy. E-mail addresses: pasquale.parisi@uniroma1.it, parpas@iol.it (P. Parisi). 1525-5050/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.yebeh.2011.03.004 Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh