Migraine and “Altered Consciousness”

You’re more likely to associate altered consciousness with conditions like epilepsy, or something sudden like a stroke. But sometimes the diagnosis should be migraine.

Migraine certainly can feature some unusual symptoms, and different levels of consciousness is one of them. This is most often associated with a type of migraine called migraine with brainstem aura. But because it’s unusual, it can lead to misdiagnosis, as happened recently.

A 16-year-old was experiencing attacks where she would get a severe, throbbing headache with vertigo. She would fall down, and even temporarily lose the ability to speak. Then the episode would pass.

Not surprisingly, an EEG was ordered, and she was diagnosed with a kind of epilepsy. But the medications for epilepsy didn’t work – and the attacks continued, 2-5 times a month.

Finally, the diagnosis was changed to migraine – and migraine treatments did work.

There is a lot of discussion about the relationship of migraine with epilepsy. And sometimes the differentiation isn’t as clear as we would like. Research certainly needs to continue, so that we can understand both conditions better.

But in the meantime, the important thing for patients is finding a treatment that works. If the common treatments for something aren’t working, it would be a good time to rewind and take another look at the symptoms, and also the medical history of the family (in this case, the patient’s mother did suffer from headaches).

Headache specialists and researchers may be interested in looking at more of the technical details of this particular case. It was published this month in Acta Epileptologica: A case of migraine misdiagnosed as epilepsy.