Differentiating migraine from epilepsy

Migraine and epilepsy are distinct entities that share many features. They are both chronic neurologic disorders with episodic manifestations and have similarities of classification, ictal progression, and symptomology, particularly in the setting of migraine with aura. At times, the distinction between migraine and seizure is challenging, as outlined in this paper. Seizures with visual manifestations may be confused with migraine aura, while altered consciousness during a migraine may be difficult to distinguish from complex partial seizure. Electroencephalography, while not routinely indicated in migraine, may be useful in distinguishing migraine from epilepsy, particularly in patients with both disorders. Differentiating migraine from epilepsy is usually accomplished on clinical grounds, but challenges exist.