The occipital lobe is deemed to be the brain structure most responsible for both the development of migraine [
24,
25] and occipital lobe epilepsies [
26]. In particular, both occipital epilepsies and migraine are characterized by visual symptoms (elementary visual hallucinations vs. aura) followed by headache and other autonomic symptoms. However, recognition of headache as an epileptic manifestation per se (rarely even the sole epileptic manifestation) still represents a challenge [
2‐
7,
10,
11,
15‐
20].
So, what would be the clinical, EEG and neuroimaging features of IEH? Literature data suggest that migraine as a sole manifestation of a seizure might be the expression of a non-convulsive SE [
4‐
7,
16‐
20], the nature of which could be diagnosed only by EEG recordings [
6,
7,
16‐
20]. Unfortunately, there is no specific EEG picture but, on the contrary, different EEG patterns associated with IEH have been recorded during migraine-like complaints in these patients [
6,
7,
16‐
20]: (1) high-voltage, rhythmic, 11–12 Hz activity with intermingled spikes over the right temporo-occipital regions [
19,
20]; (2) high voltage theta activity intermingled with sharp waves over occipital region [
4,
17] and, (3) bilateral continuous spike-and slow-wave discharges [
18]. Furthermore, a photoparoxysmal response (PPR) [
17] in combination with complaints about a light pulsating headache was seen during intermittent photic stimulation [
4]. In this respect, we would also like to stress that there could even be an isolated epileptic headache without any other associated ictal epileptic manifestations nor EEG abnormalities recognizable by scalp EEG recording, whose ictal origin can be conversely demonstrated by depth electrode studies (see patient number 2 by Laplante et al. [
27]); accordingly, on the other hand, as we all know, in other types of epilepsy, such as in frontal lobe epilepsy, often (from 20 to 40% of patients) it is not possible to detect any ictal epileptic activity from the scalp-EEG recording [
28].
Regardless of the aetiology, brain MRI showed secondary brain lesions in the right temporo-parieto-occipital region with a restricted diffusion in the right occipital region [
19,
20] or enlarged sulci in the right parietal region [
17]. However, IEH has also been reported in patients with idiopathic epilepsy [
4,
18].