A relationship between epilepsy and migraine has long been postulated,
but the nature of this interaction is still debated. We observed this
association in a 23-year old man with a history of migraine with visu
al aura who had seizures at age 15 years while watching television. Wa
king EEG was normal, but sleep recordings demonstrated posterior spike
-waves during sleep. During intermittent photic stimulation (IPS), a p
hotoparoxysmal response occurred, maximum in occipital areas. Brain ma
gnetic resonance imaging scan was normal. Seizures did not recur after
4-year treatment with valproate. He is currently seizure-free, but co
ntinues to have rare migraine with visual aura. The role of spreading
depression or of a putative dopaminergic failure in occipital cortex i
s discussed.