Migraine with brainstem aura presenting as recurrent hypersomnia (Kleine-Levin syndrome)

Recurrent hypersomnia, or Kleine-Levin syndrome, is rare and frequently causes substantial diagnostic anxiety and delay. Patients often undergo multiple investigations to rule out other causes of encephalopathy. The treatment options are unsatisfactory. Migraine with brainstem aura has not previously been widely considered in the medical literature as a differential diagnosis. We describe two patients referred to a tertiary sleep neurology service with a putative diagnosis of Kleine-Levin syndrome. Each described attacks of hypersomnia with elements of migraine with brainstem aura, in addition to having a history of migraine with aura. Simple acute migraine treatment clearly attenuated further attacks. These cases generate discussion as to the common features and potential mechanisms underlying both disorders. Furthermore, they highlight a hitherto underexplored alternative diagnosis of Kleine-Levin syndrome. This provides scope for offering established and effective migraine treatment options to patients who with a potential misdiagnosis of Kleine-Levin syndrome, providing scope for offering established and effective migraine treatment to some patients originally diagnosed with a rare condition for which there is no current consistently effective therapeutic options.