Epilepsy, Migraine, and EEG Abnormalities in Children: A Review and Hypothesis

SYNOPSIS The relationship between migraine and epilepsy is reviewed. Recurrent paroxysmal episodes in children and their relationship to electroencephalographic abnormalities is discussed. Relevant literature concerning the 14 and 6/second positive spike pattern is also surveyed. The electroencephalographic data from a group of 116 pediatric headache patients was conpared to a group of 93 children previously diagnosed with seizure disorders. In the headache group, the 14 and 6/second positive spike abnormality was seen in 40.7% of the abnormal recordings, either by itself or with other abnormalities, and in 12.2% of all EEGs performed. This pattern was found in 6.5% of all abnormal EEGs and in 4.3% of all EEGs performed in the seizure group. It is hypothesized that the 14 and 6/second positive spike pattern is a marker for autonomic hyper‐reactivity and is most readily found in children under 16 years of age. The use of the electroencephalogram in the pediatric headache work‐up is emphasized to differentiate the “Seizure Equivalent” headache disorder from migraine. Anticonvulsant medication is the appropriate treatment for the “Seizure Equivalent” headache disorder.