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SYNOPSIS

A 12-year-old girl presented three distinct attacks of classic migraine. In all attacks, an occipital seizure with impairment of consciousness was intercalated between the visual prodrome and the headache. A right occipital epileptogenic focus was detected by the EEG. Neurologic examination was normal. CT-scan and laboratory work were unremarkable. Flunarizine treatment controlled both the migraine and seizure components. Periodic migraine episodes with visual phenomena occurred in three other female components of the same family. However, the attacks were never associated with epileptic manifestations. Only the 10-year-old sister, who suffered from common migraine, showed sporadic interictal EEG abnormalities in the right posterior leads.

The possible neurophysiologic interplay between classic migraine and epilepsy in intercalated attacks may be explained on the basis of the “spreading depression” mechanism. The intense neuronal excitation preceding the migraine aura might play a “triggering” role on the occipital epileptogenic focus.

Similarities and differences between this benign though unusual syndrome and other forms of epilepsy in childhood, are also discussed.