Migraine and Epilepsy: Review of the Literature

Barbara L. Nye, MD; Vijay M. Thadani, MD, PhD

Disclosures

Headache. 2015;55(3):359-380. 

In This Article

Abstract and Introduction

Abstract

Migraine and epilepsy are disorders that are common, paroxysmal, and chronic. In many ways they are clearly different diseases, yet there are some pathophysiological overlaps, and overlaps in clinical symptomatology, particularly with regard to visual and other sensory disturbances, pain, and alterations of consciousness.

Epidemiological studies have revealed that the two diseases are comorbid in a number of individuals. Both are now recognized as originating from electrical disturbances in the brain, although their wider manifestations involve the recruitment of multiple pathogenic mechanisms. An initial excess of neuronal activity in migraine leads to cortical spreading depression and aura, with the subsequent recruitment of the trigeminal nucleus leading to central sensitization and pain. In epilepsy, neuronal overactivity leads to the recruitment of larger populations of neurons firing in a rhythmic manner that constitutes an epileptic seizure. Migraine aura and headaches may act as a trigger for epileptic seizures. Epilepsy is not infrequently accompanied by preictal, ictal, and postictal headaches that often have migrainous features.

Genetic links are also apparent between the two disorders, and are particularly evident in the familial hemiplegic migraine syndromes where different mutations can produce either migraine, epilepsy, or both. Also, various medications are found to be effective for both migraine and epilepsy, again pointing to a commonality and overlap between the two disorders.

Introduction

Migraine and epilepsy are both common disorders. Migraine affects about 12% of the general population, with 2% suffering from chronic migraine.[1,2] The lifetime prevalence of epilepsy may be as high as 4%, with the adult population having a prevalence of about 1%.[3] It appears that there is no gender predominance in epilepsy, whereas in migraine, females are more affected than males, and after puberty, the difference becomes more prominent as women make up more than 75% of the patient population.[3]

Migralepsy was a term first used by William Lennox to describe a syndrome of migraine with aura where the migraine is almost immediately followed by an epileptic seizure in a way that gives rise to the suspicion that the one triggered the other.[4,5] The opposite may also be true in that occipital lobe epilepsy can be associated with intractable headache, with or without scintillating visual phenomena.[6,7] The headaches that follow seizures may have mechanisms in common with migraine in that both can be relieved by sumatriptan.[8] The International Classification of Headache Disorders (ICHD)-3 beta criteria include the diagnosis of migraine aura-triggered seizure (1.4.4) that is described as a seizure occurring within 1 hour of the migraine.[9]

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