The value of the EEG for evaluation of patients with headache, and the interrelationship of migraine and epilepsy remain unsettled issues. Three patients with the syndrome of aphasia, headache, and left temporal spikes, all of whom were successfully treated with phenytoin, suggest a common pathophysiology. Since the symptoms in these patients lack some of the cardinal features of migraine, and yet fulfill definitions of epileptic disturbance, it is probably worthwhile to recognize this syndrome as an epileptic disturbance which appears responsive to phenytoin. These three cases also serve to emphasize the remaining value of the EEG as a diagnostic tool even in the age of radioisotope and computerized tomography scanners.