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  • Updated 04.27.2020
  • Released 03.13.2001
  • Expires For CME 04.27.2023

Migraine and epilepsy

Introduction

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. In clinical practice the comorbidity and nosological similarity of migraine and epilepsy highlight the importance of differentiation between both disorders. The author explains the details and the latest study findings in this article.

Key points

• Migraine and epilepsy are nosologically similar and both encompass four 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.

• 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 (34). 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 (56). 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" (27). Gowers in 1907 explored the many interrelationships between these two disorders and the difficulties in separating them (21). 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 International Classification of Headache Disorders, third edition (ICHD-III)(Headache Classification Committee of the International Headache Society (IHS) 2018). Notably, the International League Against Epilepsy classification does not include any definition.

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