Migraine as an underrecognized functional disability with implications for driving safety

Background Migraine impairs daily functioning, including driving, but its impact relative to epilepsy remains underexplored. While epilepsy is well-known to increase driving accident risk, the impact of migraine on driving safety remains underexplored. We aimed to compare driving risks between the two groups. Methods We conducted a 3-month observational, cross-sectional study. Consecutive patients with migraine or epilepsy attending a tertiary outpatient clinic, all holding a driving license, completed questionnaires collecting sociodemographic, clinical data, and accident history. Results A total of 135 patients participated: 77 with migraine and 58 with epilepsy. Migraine predominated among females, while epilepsy among males [84% (65/77) vs. 68% (26/38), p < 0.001)]. Educational level was lower in epilepsy patients ( p < 0.001). In epilepsy, 62.7% (32/51) reported seizures with impaired consciousness; 67.2% (39/58) had fewer than one seizure per trimester. In migraine, 66% (51/77) reported visual aura. Accident history was more frequent in migraine than epilepsy [54.5% (42/77) vs. 31% (18/58), p = 0.009] but accidents attributed to neurological causes were comparable [20.5% (8/39) aura-related vs. 18.8% (3/16) seizure-related, p = 0.882]. Most patients with migraine (54/77, 70%) refrained from driving during attacks; 23% (18/77) supported legal driving restrictions. Conclusion Migraine may confer a driving accident risk comparable to epilepsy, underscoring the need for individualized clinical risk assessment.