Ictal headache and photosensitive seizures are often diagnosed incorrectly as migraine or what people call it, “miralepsy” is most unlikely to happen but an “epilepsy-migraine sequence” exists and is well acknowledged than the general view of a “migraine-epilepsy sequence”. Their relevant theories are required to be brought into attention of doctors in clinical practice as well as ICHD (international classification of headache disorders) because of the results this misdiagnosis may have on patients.
Migraines and Seizures
Misdiagnosis especially between migraines and seizures is significant however their differentiation on the basis of clinical ground should 
not be problematic. The main issue that causes misdiagnosis is that the importance is unduly given on noting individual’s symptoms, rather than on an all-inclusive systematic analysis of the clustering, chronological sequence or other quality features. These are some of the basic instances where seizures occurring from flashing lights are incontrovertibly diagnosed as migraine combined with aura (if headache happens after a seizure), basilar migraine with occipital convulsions (which is false, as this is a syndrome of idiopathic childhood occipital epilepsy) or acephalgic migraine. The seizures that develop after seeing flashing lights is usually short in duration (1-2 minutes) are typically circular or colored. These are clinically different from the visual aura of migraine, which develops slowly and steadily, is long in duration (≥6 minutes) and largely linera and achromatic patterns.
Ictal Headache
In many publications, headache is very well known to be a symptom of epileptic seizure. However, this ictal headache displays varied symptomatology, such as:
- Nebulous ache in the head
- Bi-frontal pressure
- Sensation of electricity passing through the head of varying strength, uneasiness and localization
- Sharp intense retro-orbital discomforts
These are known as cephalic sensations that occur with or without true headache and show its symptoms in the beginning or after the progression of an annexation. As a tenet, ictal headache is commonly associated with seizures. It may be a rare case that headache is the sole reason behind a seizure and this is more unlikely to be found in patients. Ictal headache should not be confused with migraine as this only happens in rare and exceptional conditions referred to as status epilepticus migrainosus.
Hemicrania Epileptica and Migraine
Ictal headaches are a common occurrence with photosensitive epilepsy but they should not be considered migraine pain. A Hemicrani epileptica very rare epilepsy condition shows symptoms of headache that lasts for several minutes, with features of migraines and seizures. The patient undergoing epileptic seizure develops headache along with seizure. As soon as the seizure is over, headache also stops immediately. This condition is known as status epilepticus migrainosus which is very rare and only very cases have been described so far.
Final Words
There are many uncertainties and high rate of misdiagnosis of photosensitivity epilepsy with migraine, which calls for an advanced medical research in nature of headaches and their effect on epilepsy. Achieving clear decisions on the relationship between photosensitive epilepsy and migraine can be challenging but now is the time for this to happen. So don’t confuse migraine pain with seizures caused by flashing objects or lights, consult your physician for the right treatment.