Migraine plus epilepsy.

As I NOTED in another paper, whenever I see a patient with a severe, bizarre, or long-lasting migraine refractory to treatment, I suspect that I am dealing with migraine plus something else -such as a mild psychosis, an unrecognized epilepsy, a cerebral arteriosclerosis, or a constitutional inadequacy. Elsewhere, I have described a series of patients with migraine plus a mild psychosis. Now I present cases in which migraine was complicated by a mild epilepsy or an epileptic carrier state. In 1912, I saw a man in his thirties with a migraine so severe that I suspected the presence of an extra component. I learned that he had a brother whose life has been ruined by epilepsy. I put my patient on the then-used bromides, and he was much relieved. Ever since then, whenever I have seen a patient with an unusually severe migraine, or migraine that persisted in a severe form into the patient’s later years, I have asked if he had epileptic or violent-tempered or psychotic forebears, and often I have learned that he had some. I am particularly suspicious of an epileptic component when the patient keeps getting severe migraines without any obvious exciting cause. Then I wonder if the triggers could be little epileptic storms in the brain, and, when I get electroencephalograms made, I may find the expected signs of seizure activity. As most physicians know, in cases of pure migraine in which no epilepsy occurs in the patient’s family, the electroencephalograms are nor~nal .~ Are migraine and epilepsy related? Several authorities have claimed that migraine and epilepsy are related, but I cannot helieve this. 11 The 2 diseases usually appear in different types of persons with different temperaments. 21 Migrainous persons, who know of no epilepsy or psychosis in their family, usually have normal electroencephalograms. 31 Anticonvulsive drugs do not help the person with a pure migraine. 41 Persons with ordinary, mild migraine rarely have epilepsy or epileptic relatives. However, when I went at the investigation the other way around and started with relatives of epileptics, I found 21% had had sick headaches.’ In 1933, Peter Bassoe, starting with 200 eFileptic patients, found that 28% had some migrainous relatives2 Like me and some others, he had found very few migrainous patients with epilepsy or with epileptic relatives. At first glance, the high incidence of migraine among the relatives of epileptics suggests a relationship between the 2 diseases, but when I studied the relatives of 574 psychotic and alcoholic patients, I found that 23% had had migraine. So far as I know, no one has suggested that migraine is related to psychosis; in fact, as some observers have noted, most migrainous persons are unusually sensible and sane. The probable explanation for the figures obtained is that, when migraine is uncomplicated, a high percentage of the patients have such a mild syndrome that they never mention it to a physician. But when patients have migraine plus a mild psychosis or epilepsy, the syndrome is usually so severe and incapacitating that when they visit a physician they will surely complain about it. The incidence of migraine. Unfortunately, no one can guess what the incidence of migraine is in the United States or in any particular group within the United States. No 2 men agree on what is mild migraine, and most of them diagnose the disease only in its less common severe forms. Because migraine is a disease of bright, wide-awake, well-educated persons, the incidence in any particular group must depend on the average education and social position of the people in the group. The figures to be found in the literature range from 1.6 to 53%. Reported cases of migraine plus epilepsy. In his great book, Megrim and Sick Headache written in 1873, Edward Liveing, mentioned families in which migraine was mixed with