The visual aura is perhaps the most well known feature about migraine headaches. However this has an important clinical pitfall. Occipital lobe seizures can also have similar auras. The important point to remember is that the visual phenomena of migraine last for four minutes or less, show linear , zig zag and achromatic or black and white patterns. (Panayiotopoulos, Epileptic Disord, 1999 Dec, 1:4; 205-16) If the visual phenomena during a headache deviates from this characteristic migraine pattern it is important to consider occipital lobe seizures. Colored patterns, patterns that multiply rapidly in the visual field and moving / rotating patterns all raise the possibility of occipital lobe seizures. Some of this seizure activity can even spread anteriorly and cause temporal lobe manifestations. An EEG can contribute significantly towards differentiating between occipital lobe seizures and migraines; this is a very important differentiation with profound implications.There have been instances of occipital partial status epilepticus being misdiagnosed as migraine . (Walker MC, Epilepsia, 1995 Dec 36:12, 1233-6) The other headache scenario in which EEG is indicated is when the headache is associated with alteration of awareness in which case we have to consider seizures. It is of interest to note that sometimes we see children with known seizure disorder who seem to be doing well on medications with no seizures reported until we ask them how often they get headaches. Often times they will tell us that they are getting headaches every day and then it turns out that those headaches are actually post-ictal headaches.