PSYCHOGENIC BASILAR MIGRAINE - REPORT OF 4 CASES

We discuss four patients with the clinical diagnosis of basilar migrai ne and suspected coexisting epilepsy who were referred to our epilepsy center. Their symptoms suggested episodic dysfunction in the distribu tion of the basilar artery, followed by pulsating headache with nausea . Verbal unresponsiveness and sensory symptoms occurred in all four pa tients; two also had focal paresis or jerking movements. Diagnostic st udies excluded other disorders with similar symptoms. None of the pati ents improved with antimigraine or antiepileptic drugs. Provocation te sts with suggestion elicited typical events in three patients and aura and headache in one patient. There were no EEG or ECG abnormalities d uring spontaneous or provoked episodes. Two patients improved with psy chiatric treatment. Conversion disorder or malingering should be consi dered in patients whose symptoms of basilar migraine are atypical or r efractory to treatment.