The remaining seven patients had intercalated seizures. In another five patients, the two types of attacks were quite distinct, but often an epileptic seizure was followed by a migraine attack and vice versa. The two conditions appeared to be coincidental in four of the sixteen patients. They found that 16 of 450 patients with migraine (3.6%) also had seizures. Manzoni et al and Terzano et al coined the term intercalated seizures to denote epileptic seizures occurring between the migrainous aura and the headache phase of migraine. In addition, the EEG during migraine aura may show "waxing and waning" patterns, separated by completely normal EEG activity despite the persistence of clinical symptoms. However, in most reported cases, the EEG does not show the usual temporal evolution with progressive increases and declines in the frequency and amplitude of rhythmic, repetitive, epileptiform activity typical of ictal EEGs in epilepsy. During migraine aura, bursts of spike activity may resemble the ictal EEG during an epileptic seizure. In two patients, the entire migraine–epilepsy sequence was captured it showed changes during the clinical migraine aura that were atypical for electrographic epilepsy.
Marks and Ehrenberg studied patients with migralepsy using multiple 24-hour video-EEG telemetry recordings. The EEG and 24-hour closed-circuit television (CCTV) EEG recording can help differentiate migraine aura and epileptic aura these procedures can also facilitate the diagnosis of comorbid epilepsy and migraine as well as the migralepsy syndrome.
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