Migraine and epilepsy

Wei-Ta Chen MD (Dr. Chen of Taipei Veterans General Hospital has no relevant financial relationships to disclose.)
Shuu-Jiun Wang MD, editor. (Dr. Wang of the National Yang-Ming University School of Medicine and the Neurological Institute, Taipei Veterans General Hospital received consulting fees from Eli Lilly.)
Originally released March 13, 2001; last updated August 22, 2016; expires August 22, 2019

Overview

The association between migraine and epilepsy was established more than a century ago. Both disorders are interrelated in epidemiological, clinical, and pathophysiological studies. Moreover, evidence has been mounting for a shared genetic susceptibility to migraine and epilepsy. Despite the close relationship between migraine and epilepsy, comorbidity of both disorders remains under debate with respect to nosology and terminology. The new headache classification criteria, ICHD-III beta, recognizes 3 seizure-related headaches, whereas pertinent disorders are not defined by the International League Against Epilepsy. The author explains the details in this article.

Key points

 

• Migraine and epilepsy are nosologically similar and both encompass 4 phases in their attacks: premonitory, aura, ictal, and resolution.

 

• Migraine and epilepsy are clinically related disorders because migraine may follow (postictal migraine) or trigger (migralepsy) seizure attacks.

 

• Migraine and epilepsy are epidemiologically interrelated because patients with migraine have a higher chance of also having epilepsy.

 

• Recent data suggest the comorbidity of migraine and epilepsy may have shared genetic links altering cerebral excitability.

 

Anticonvulsants are the choice of treatments for comorbid migraine and epilepsy.

Historical note and terminology

Migraine and epilepsy have been well-recognized medical entities since antiquity. Aretaeus of Cappadocia (second century A.D.) was probably the first to write on the occurrence of headache with gastrointestinal disturbance and visual symptoms. In 1873, Liveing published his book, On Megrim, Sick-Headache and Some Allied Conditions, which provided a systematic account of migraine and described many of its variants (Liveing 1873). Graham and Wolff proposed the first comprehensive theories on the cause of migrainous symptoms in their epochal text published in 1938.

Epilepsy was known as the “falling sickness” in medieval Europe and was believed to be caused by demonic possession (Temkin 1945). It was not until the mid-19th century that bromides and barbiturates provided the first effective therapy for this condition.

The coexistence of both these conditions was first pondered by Jackson in 1875, who stated, "I have seen cases intermediate in type between migraine, epileptiform seizures, and epilepsy proper" (Jackson 1875). Gowers in 1907 explored the many interrelationships between these 2 disorders and the difficulties in separating them (Gowers 1907). He concluded that they were fundamentally different, saying, "Some surprises may be felt that migraine is given a place in the borderland of epilepsy, but the position is justified by many relations, and among them by the fact that the 2 maladies are sometimes mistaken, and more often their distinction is difficult."

To date the terminology of seizure-related headaches is still under debate. The only international classification that defines seizure-related headaches and related manifestations is the ICHD-III beta (Headache Classification Committee of the International Headache Society (IHS) 2013). Notably, the International League Against Epilepsy classification does not include any definition.

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