A Narrative Review of Visual Hallucinations in Migraine and Epilepsy: Similarities and Differences in Children and Adolescents

Abstract

Since the earliest descriptions of the simple visual hallucinations in migraine patients and in subjects suffering from occipital lobe epilepsy, several important issues have arisen in recognizing epileptic seizures of the occipital lobe, which often present with symptoms mimicking migraine. A detailed quantitative and qualitative clinical scrutiny of timing and characteristics of visual impairment can contribute to avoiding mistakes. Differential diagnosis, in children, might be challenging because of the partial clinical, therapeutic, and pathophysiological overlaps between the two diseases that often coexist. Ictal elementary visual hallucinations are defined by color, shape, size, location, movement, speed of appearance and duration, frequency, and associated symptoms and their progression. The evaluation of the distinctive clinical features of visual aura in migraine and visual hallucinations in occipital epilepsy could contribute to understanding the pathogenetic mechanisms of these two conditions. This paper aims to critically review the available scientific evidence on the main clinical criteria that address diagnosis, as well as similarities and differences in the pathophysiological mechanisms underlying the visual impairment in epilepsy and migraine.

Keywords: aura; children; epilepsy; headache; migraine; visual hallucinations.

Figure 1

Graphical representation of phosphenes. We report two explanatory drawings, drawn by two children who arrived at the Department of Neuropsychiatry of Di Cristina Hospital in Palermo. (A) Graphic representation of phosphenes in a child with occipital epilepsy with seizure without loss of consciousness. (B) Graphic representation of phosphenes in a child with migraine with aura. The high similarity between the two symptoms complicates the differential diagnosis. (Courtesy of Dr. V. Raieli).

Figure 2

Graphical representation of blindness. We report explanatory drawing of blindness, drawn by a child with migraine who visited the Department of Neuropsychiatry of Di Cristina Hospital in Palermo. Translation of the written portion: “I don’t see anything”. (Courtesy of Dr. V. Raieli).