Patients with psychogenic nonepileptic seizures report more severe migraine than patients with epilepsy

• More frequent and longer migraines are reported by PNES vs. epilepsy patients.
• Non-visual migraine auras are more common in PNES patients vs. epilepsy patients.
• 1/2 of PNES patients with migraine feel their migraines are inadequately treated.
• PNES patients should be screened for migraine, and if present, offered treatment.

PurposeClinical observations suggest that psychogenic non-epileptic seizure (PNES) patients often have severe migraine, more severe than epilepsy patients. Investigations into migraine characteristics in patients with PNES are lacking. In this study we tested the hypothesis that, compared to epilepsy patients, PNES patients have more severe migraine, with more frequent and longer duration attacks that cause greater disability.MethodIn this observational study, 633 patients with video-EEG proven epilepsy or PNES were identified from the Mayo Clinic Epilepsy Monitoring Unit database. Contacted patients were screened for migraine via a validated questionnaire, and when present, data regarding migraine characteristics were collected. Two-sample t-tests, chi square analyses, and Mann–Whitney U tests were used to compare migraine characteristics in PNES patients to those of epilepsy patients.ResultsData from 43 PNES patients with migraine and 29 epilepsy patients with migraine were available. Compared to epilepsy patients, PNES patients reported having more frequent headaches (mean 15.1 ± 9.8 vs. 8.1 ± 6.6 headache days/month, p < .001), more frequent migraine attacks (mean 6.5 ± 6.3 vs. 3.8. ± 4.1 migraines/month, p = .028), longer duration migraines (mean 39.5 ± 28.3 vs. 27.3 ± 20.1 h, p = .035), and more frequently had non-visual migraine auras (78.6% vs. 46.7% of patients with migraine auras, p = .033). Migraine-related disability scores were not different between PNES and epilepsy patients (median 39, interquartile range 89 vs. 25, interquartile range 60.6, p = .15).ConclusionCompared to epilepsy patients with migraine, PNES patients with migraine report having a more severe form of migraine with more frequent and longer duration attacks that are more commonly associated with non-visual migraine auras.