Migraine and Epilepsy
Did you know that patients with epilepsy have a higher incidence of migraine headaches (and vice-versa!)? Patients are usually referred to our clinic for evaluation of their seizures. I will routinely ask patients about their headaches. If the patient has problematic headaches, treatment of the headaches may dramatically improve their quality of life.
It is not common, but sometimes an aura for a migraine can trigger a seizure. This shows the overlap in pathophysiology- between migraine and epilepsy. The best thing for the patient is to treat the migraine and treat the seizure activity. Sometimes, one medication can treat both: “kill two birds with one stone!”
Some interesting/important points about migraine and epilepsy:
- Migraines can trigger seizures. Migraine triggered seizures are defined as seizures that occur within one hour of a migraine aura. The migraine aura is the warning that patients get before the headache gets severe- for example, patients may see flashing lights that slowly move across their visual fields. Patients may also have nausea that builds up over several minutes as their aura.
- Patient example: 28 year-old woman with a history of migraines and epilepsy for several years. The patient would note her migraine aura. This was a visual change—flashing lights that slowly moved from left to right across her visual field. The aura would become more intense over 10 minutes. Eventually, the symptoms could lead into a seizure (not always, but every few months)—patient would stare, lose contact, smack her lips and pick at her clothes. The seizure would last 60 seconds. She would then come out of the seizure. Although she would be mostly recovered, the patient would often be left with a headache. Headaches were often a throbbing pain on one side of her head. Headaches were associated with nausea, light and sound would bother her. Headache would last for hours. Patient would often want to go lay down in a dark room.
- Migralepsy: this is the term for migraine-triggered seizure.
- Rates of migraine triggered seizures: In patients who have both epilepsy and migraine, migraine was noted to trigger seizures in 1.7-16% of patients.
- The prevalence of migraine in patients with epilepsy has been shown to be approximately 24%.
- Patients with epilepsy are 2.4 times more likely to be diagnosed with migraine (compared to the general population).
- 37%-51% of patients experience headaches after their seizures. These are called postictal headaches. These headaches can be as problematic as the seizures, for some patients.
- Mechanism of migraine and epilepsy:
- Neurons are more active in both migraine and in epileptic seizures. A seizure, of course, is due to abnormal electrical activity coming from the brain. A migraine aura is due to cortical spreading depression (CSD). CSD is a wave of electrical activity that slowly moves across the cerebral cortex. The abnormal electrical activity in a migraine aura moves more slowly than the typical spread of a seizure. One certainly can see how a migraine aura could trigger a seizure—the abnormal electricity of a migraine aura, in a patient with epilepsy, could trigger neuronal excitation and a seizure.
- Treatment can “kill two birds with one stone”.
- Certain medications can effectively treat both migraine headaches and epileptic seizures.
- Such medications include topamax and depakote.
- Possible reason that seizure medications work in migraine and epilepsy- similar mechanisms (both cause abnormal neuron excitation—see paragraph above).
Forderreuther S, Henkel A, Noachtar S, Straube A. Headache associated with epileptic seizures: epidemiology and clinical characteristics. Headache 2002;42:649-55.
Haut SR, Fishman O, Lipton RB. Migraine, migralepsy and basilar migraine. In: Atlas of epilepsies. Edited by CP Panayiotopoulos. Pp 629-637. Springer Verlag, London 2010.
Silberstein SD, Lipton RB, Haut S. Migraine. In: Epilepsy: A comprehensive textbook. Edited by Jerome Engel and Timothy Pedley. Pp 2733-2743. Lipppincott Williams & Wilkins, Philadelphia 2008.
Dr. White has been practicing as a full-time epileptologist since 1999. His practice focuses on optimizing the diagnosis and treatment of patients with seizure disorders. Dr. White’s special interests include patient education, improving the side-effect profile of seizure medications, and epilepsy surgery.