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Migraine and Epilepsy

Written by Kerrie Smyres on 2nd Apr 2015

Whether or not there’s a connection between migraine and epilepsy is a question many patients ask. After all, many migraine preventive drugs are anticonvulsants, patients describe similar warning signs and aftereffects of a migraine attack or a seizure, and epilepsy can induce a headache that can be relieved by the acute migraine drug sumatriptan (Imitrex). A recent article published in the journal Headache explores the relationship between the two disorders, which share many similarities.

About 12% of the population has migraine and 1% to 3% have chronic migraine. Among adults in the Western world, approximately 1% have epilepsy, but looking at overall lifespans, as many as 4% could have epilepsy. People with epilepsy are twice as likely to have migraine as those without epilepsy. Children with migraine are three to four times more likely to develop epilepsy than those without migraine.

Both migraine and epilepsy attacks have four phases (premonition, aura, ictal, and postictal). Because the sequence of events is similar, the article’s authors believe that, while the underlying mechanisms aren’t necessarily the same, the two disorders share biological characteristics. Some similarities in the four stages include:

Premonitory phase: Hours to days before the pain of a migraine attack, patients experience fatigue, nausea, neck stiffness, photophobia, phonophobia, yawning, and pale skin. Although they are less well-defined, people with epilepsy can have similar symptoms between 10 minutes and three days.

Aura phase: Both disorders can have a visual aura. With migraine, the aura tends to be shimmering sparkling and/or a dark spot in the vision that’s usually black and white. It can last for a few minutes or an hour (and, on the rare occasion, even longer than that). The visual aura in epilepsy is usually colored and has circular patterns. It usually lasts from seconds to a minute.

Other migraine aura symptoms include disturbances of taste and smell, dizziness, a prickling or tingling sensation, and feeling out of it. Similarly, epilepsy aura can include dizziness and a prickling or tingling sensation, though it can also include a sense of disorientation in space.

Ictal phase: In migraine, this is often called the pain phase; in epilepsy it is the seizure phase. Although head pain and seizures are unlikely to be confused with each other, the other symptoms of the two disorders can be similar. The paper’s authors say that those symptoms resemble each other so much that sometimes migraine can be diagnosed as epilepsy and epilepsy diagnosed as migraine.

Postictal phase: Fatigue, lethargy, and exhaustion follow the pain phase for migraine and the seizure phase for and epilepsy. This is the stage that’s often called a migraine hangover.

While there is overlap between the two disorders—both involve electrical activity in the brain and both can be connected to some similar genes—they are distinct from one another. The paper’s authors hope that as research tools, like brain imaging, and treatments for both disorders advance, we’ll learn more about the similarities and differences between migraine and epilepsy.

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REFERENCE

Nye, B. L. & Thadani, V. M. (2015). Migraine and Epilepsy: Review of the Literature. Headache, 55(3), 359-380.

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