A Hypothesis-Driven Multimodal Diagnostic Framework Integrating TMS-Evoked Cortical Excitability, EEG-Derived Electrophysiological Signatures and Plasma CGRP Quantification to Explore their Complementary Diagnostic Potential in Differentiating Migraine with Aura from Occipital Lobe Epilepsy

Migraine with aura and occipital lobe epilepsy share overlapping visual manifestations, often creating diagnostic challenges and potential misclassification. Both conditions involve distinct patterns of cortical excitability, electrophysiological activity, and neuropeptide signalling. This review proposes a multimodal diagnostic framework integrating transcranial magnetic stimulation (TMS)-evoked cortical excitability, electroencephalography (EEG) patterns, and calcitonin gene-related peptide (CGRP) levels to explore their differential diagnostic potential. The proposed approach encompasses TMS-based assessment of cortical excitability, EEG characterization of occipital electrical activity, and plasma CGRP quantification using enzyme-linked immunosorbent assay (ELISA). These parameters will be conceptually integrated into a web-based clinical decision-support algorithm. This framework aims to improve differential diagnostic accuracy, minimize misclassification, and facilitate appropriate therapeutic decision-making through a reproducible, multimodal approach.