Among the clinical interrelationships between headache and epilepsy are certain syndromes in which the two conditions are associated. Two of these are:

  • benign occipital epilepsy of childhood with occipital paroxysms
  • benign rolandic epilepsy

Benign occipital epilepsy of childhood with occipital paroxysms

Benign occipital epilepsy of childhood (BOEP) is a clinical syndrome characterized by visual symptoms followed by a partial seizure and postictal migraine. The EEG reveals occipital spikes. A rare syndrome of childhood (mean age of onset is 7.5 years), it accounts for less than 5% of epilepsy in children.57–59

BOEP has features of both epilepsy and migraine.58,60,61 The seizures usually begin with visual symptoms, including:58,62,63

  • amaurosis
  • elementary visual hallucinations (phosphenes)
  • complex visual hallucinations (visual illusions), including micropsia, metamorphopsia, or palinopsia

The visual symptoms are often followed by hemiclonic, complex partial, or generalized tonic-clonic seizures. After the seizure, approximately 25–40% of the patients develop migrainelike headaches.61

The interictal EEG is characterized by normal background activity and distinct occipital discharges. The occipital spikes typically have a high voltage (200–300 mV), diphasic morphology, and a unilateral or bilateral occipital and posterotemporal distribution. The spikes disappear with eye opening and reappear 1 to 20 seconds after eye closure.

Gastaut reviewed the clinical and EEG features of 53 patients with BOEP. Only 55% had the complete syndrome of occipital spikes, ictal visual symptoms followed by a partial seizure, and postictal migraine. In patients with nocturnal seizures, motor symptoms predominated. In those with diurnal seizures, visual symptoms were more common. Nocturnal seizures are more common in younger children and bear a good prognosis.58,59 Seizures starting after 8 years of age are more likely to be frequent, diurnal, and persistent,58,59 although complete seizure control is achievable in approximately 60% of patients overall.

Occipital spikes are not specific for BOEP. They have been reported in people with migraine. In children younger than 4 years of age, they may not be associated with epilepsy or any other defined disorders.64–66 Occipital spikes can also be seen in other disorders, including myoclonic, absence, and photosensitive epilepsies, as well as celiac disease.58,67

For another perspective on this disorder, see Childhood epilepsy with occipital paroxysms (CEOP).

Benign rolandic epilepsy

Benign rolandic epilepsy is characterized by unilateral somatosensory or motor seizures and centrotemporal spikes. Clinical and electrographic features can shift from side to side. Speech arrest, pooling of saliva, and usually, preservation of consciousness are also typical, although spread and generalization do occur.

Most patients respond well to anticonvulsant medication. In one series, 75% of patients were seizure free after 5 years.68 The seizures almost invariably disappear by age 15 years. An association with migraine has been reported in some, but not all, studies.69,70 Rossi and coworkers71 found that migraine prevalence in male controls (11.1%) was much higher than one would expect in boys between the ages of 6 and 15 years.

Giroud and colleagues,72 in a control study, found that epilepsy with rolandic paroxysms and migraine were associated. The incidence of migraine was studied in four groups of patients:

  • patients with centrotemporal epilepsy (62%)
  • patients with absence epilepsy (34%)
  • patients with partial epilepsy (8%)
  • nonepileptic patients with a history of cranial trauma (6%)

These results suggest that centrotemporal epilepsy and, to a lesser degree, absence epilepsy are associated with migraine.72 The association between benign rolandic epilepsy and migraine may be a manifestation of the comorbidity of migraine and epilepsy in general.50

Reviewed By: 
Steven C. Schachter, MD
Thursday, April 1, 2004