AAN 2026 | Differentiating between seizure, stroke, and migraine

Part of the session, it’s actually a game show format where we have clinical scenarios, and the audience is supposed to decide if they think this is a stroke, a seizure, or a migraine. This is a question that comes up quite often in clinical practice when somebody’s had maybe even the first time that they’ve expressed one of these issues, and it’s very hard sometimes to tell the difference. So one of the things we did is present different scenarios that are specific to each condition that are oftentimes overlapping or have similar symptoms, and to talk about what additional questions may be asked, what tests may need to be performed, and how you can help distinguish between the different aspects of these. Well, you know, the first time something happens, it’s very hard to tell. Migraine itself is oftentimes defined by repeated stereotyped events. So sometimes we don’t know the first instance what’s happening, and you do have to be very conservative. You may have to manage it as if it’s a stroke, ensure that somebody has had the highest level of urgent care before making assumptions, something that may be a little less emergent to take care of. Another thing that sometimes distinguishes the difference is that strokes are often a loss of ability, and things like visual seizures or migraine, sometimes you can gain function, like see things that aren’t there. So that’s one of the cues that sometimes helps us decide between the two.

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