Reports of an association between migraine and seizures have existed for a long time. A syndrome of basilar artery migraine, seizures and abnormal EEG's has also been published. We now report four patients with seizures and migraine in whom we feel the seizures were secondary to cerebral infarctions. Migraine was of the classical type in all patients and the auras were predominantly visual, Neurological symptoms associated with the cerebral infarctions were mild or transient and could have easily been dismissed as “complex migraine”. CT scans showed cerebral infarctions involving the occipital cortex in all four cases. Two-dimensional echocardiography revealed mitral valve prolapse (MVP) in two cases and a bicuspid aortic valve in one case. In two cases, both with MVP, there were more than one cerebral infarctions.

Seizures may be an early warning of cerebral infarctions in patients with migraine and should alert the physician towards such a possibility.