Prevalence of migraine in individuals with functional seizures: A systematic review and meta-analysis

This study aimed to understand the prevalence of migraine in patients with functional seizures in general, as well as compared to patients with epileptic seizures.

We conducted a literature search of the PubMed, Scopus, and Web of Science databases from database inception until July, 2024. We identified studies using an observational design and performed a meta-analysis to evaluate the association between migraines and functional seizures. We assessed the quality of the studies with the Newcastle-Ottawa Scale, and identified the pooled odds ratios (OR) and mean differences. Heterogeneity was investigated using the I² statistic, significance was determined using Cochran's test, and a post-hoc Begg's test was performed. This study was registered with PROSPERO (CRD42024558536).

Of the 3248 studies identified, 13 studies (N = 2415) were eligible for inclusion. Out of 2415 patients with functional seizures, 763 (31.5 %) patients had comorbid migraine. The pooled OR for prevalence of migraine in individuals with functional seizures compared with those with epileptic seizures was 2.77 (95 % CI: 2.36-3.27), with a corresponding mean difference of 18 % ((95 % CI: 9 %-27 %). Quality assessment revealed moderate-to-high quality in all the included studies.

This study revealed a high prevalence of migraine in patients with functional seizures. However, existing evidence is limited to a handful of observational studies. More studies are needed to evaluate the direction of the association and the clinical and therapeutic impact of migraine on functional seizures.