Migraine triggered by epileptic discharges in a Rasmussen’s encephalitis patient after surgery

After 2 years from disconnective surgery for Rasmussen’s encephalitis, a child, 9 years old, began to present severe migraine attacks, lateralized to the operated side, lasting 1–2 days. Video/EEG recordings during two different migraine attacks, with an interval of 6 months from each other, showed, in both recordings, subsequent ictal discharges over the affected and disconnected hemisphere. Migraine and ictal discharges in both occasion disappeared with diazepam i.v. The EEGs performed during migraine-free period, on the contrary, showed very rare and mild subclinical ictal discharges. Although a casual relationship could not be excluded, a pure neuronal pathogenetic mechanism can be suggested, mediated by post- and inter-ictal cortical depression.