A case of migraine misdiagnosed as epilepsy

Area of Science:

• Neurology
• Epileptology

Background:

• Migraine and epilepsy are episodic neurological disorders with overlapping clinical features.
• A comorbid relationship exists, with some migraine patients showing epileptic discharges on EEG.
• These similarities contribute to diagnostic challenges and potential misdiagnosis.

Purpose of the Study:

• To present a case of migraine misdiagnosed as epilepsy due to overlapping symptoms and EEG findings.
• To emphasize the importance of accurate differential diagnosis between migraine and epilepsy.

Main Methods:

• A case report of a 16-year-old female patient presenting with headaches and altered consciousness.
• Long-term electroencephalogram (EEG) revealed epileptic discharges, initially leading to an epilepsy diagnosis.
• Diagnosis was revised to migraine, with treatment including ibuprofen for acute episodes and prophylactic medications (flunarizine, amitriptyline).

Main Results:

• The patient was initially misdiagnosed with epilepsy and unresponsive to anti-seizure medications (ASMs).
• Following a revised diagnosis of migraine, treatment with ibuprofen and prophylactic agents resulted in complete headache resolution within one week.
• The case demonstrated that altered consciousness during headache episodes, coupled with abnormal EEG, can be indicative of migraine.

Conclusions:

• Altered consciousness during headache episodes, alongside abnormal EEG findings, can lead to misdiagnosis of epilepsy.
• Clinicians must exercise caution and perform thorough differential diagnosis to distinguish between migraine and epilepsy.
• Accurate diagnosis is crucial for effective treatment, avoiding ineffective therapies like ASMs for migraine.