Epilepsy and Migraine: What Is the Relationship?

Epilepsy and migraine are complex brain disorders, and having one increases your chance of having the other. Despite being distinct conditions, epilepsy and migraine share several features, including triggers, symptoms, and treatments. These similarities perhaps provide insight into how the two disorders are connected.

This article explores the relationship between epilepsy and migraine, including how they can be managed simultaneously.

Connection Between Epilepsy and Migraine

Migraine and epilepsy share similar biologies, triggers, and symptoms, like headache and aura. A migraine may even trigger a seizure in rare instances.

Biology

Epilepsy and migraine are diseases involving abnormal brain electrical activity, specifically an initial period of excessive nerve cell excitability.

While both conditions may originate or be triggered by this hyperexcitability in the brain, experts speculate that the disorders eventually transition down unique pathways:

• In seizures, the hyperexcitability transitions to many nerve cells firing simultaneously.
• In migraine, the hyperexcitability possibly transitions to cortical spreading depression (CSD).

Triggers

Migraine and epilepsy are both episodic disorders, meaning they are marked by attacks or episodes of symptoms, followed by periods of recovery. These episodes can occur spontaneously or be triggered by an environmental factor.

Examples of shared environmental triggers with migraine or epilepsy include:

• Stress
• Sleep deprivation
• Menstruation
• Alcohol

Headache as a Symptom

Headaches occur in migraine and epilepsy.

Migraine headaches are throbbing and can be felt on one side of the head or both. They may be accompanied by nausea, vomiting, and sensitivity to light or noise.

Throbbing headaches that resemble migraines commonly occur with seizures, especially in the postictal state, the recovery period following a seizure.

Postictal headaches occur in around 45% of people with epilepsy and may accompany other postictal symptoms like confusion, tiredness, or dizziness.

Migraine-like headaches can also occur in the ictal state, the active stage of a seizure when bursts of electrical activity occur in the brain. Ictal headaches are overall not as common as postictal headaches.

Aura as a Symptom

Another symptom, an aura, may occur with seizures and migraine attacks.

Migraine auras precede around 15% to 30% of migraine headaches and are typically associated with visual symptoms like seeing zigzag flashing lights or bright shapes.

Sensory disturbances (e.g., numbness and tingling on parts of your body) and speech, hearing, or motor (movement-related) symptoms may also be present during a migraine aura.

Epileptic auras occur in nearly 60% of people with focal epilepsy (seizures that begin in one area of the brain) and 13% with generalized epilepsy (seizures that start on both sides of the brain).

Epileptic auras are commonly associated with stomach discomfort or psychic feelings of déjà vu, fear, or impending doom. These auras may also cause neurological disturbances, similar to a migraine aura, such as vision, sensory, or hearing symptoms. (e.g., ringing or buzzing sounds in both ears).

Migraine Aura-Triggered Seizure

A migraine with aura can lead straight into a seizure within an hour of the migraine starting. This complication of migraine is classified as a migraine aura-triggered seizure by the International Headache Society.

Risks

Compared to the general population, people with epilepsy are approximately twice as likely to have migraine. Likewise, people with migraine have a higher chance of having epilepsy, although other risk factors, like a history of head trauma, are also usually present.

Experts haven't teased out precisely why having epilepsy increases the risk of migraine and vice versa. It doesn't appear that one condition directly causes the other.

Instead, environmental factors like brain injury probably explain some cases of coexisting epilepsy and migraine. Genetic factors may also play a role.

Supporting a genetic link between the conditions is that several common genetic mutations (changes in DNA) have been discovered in families with migraine and epilepsy. 

Many of these genetic mutations lead to an imbalance between excitatory and inhibitory chemicals in the brain. This chemical imbalance plays a crucial role in the pathogenesis of epilepsy and migraine.

It's important to note that while epilepsy and migraine may coexist, there is no evidence to suggest one condition necessarily aggravates the other.

That said, they may have compounding psychological effects.  Epilepsy and migraine are both associated with a poorer quality of life and psychological difficulties such as depression, anxiety, and sexual dysfunction.

Treatment and Management of Epilepsy With Migraine

Certain epilepsy and migraine medications are used to manage both conditions.

Topamax (topiramate) and Depakote (valproate) are two prime examples. These medications are used for migraine prevention, although they were initially developed for epilepsy.

Migraine-prevention medication helps reduce the number and severity of migraines. Likewise, anti-seizure medications are intended to reduce the number or severity of a person's seizures.

Starting an anti-seizure medication (that may also be used to prevent migraine) requires a close discussion with your healthcare provider. Such medications can cause varying side effects and must be taken daily to be effective.

Keep in mind that an anti-seizure medication is ineffective at treating acute migraine attacks. Acute migraines are treated with a nonsteroidal anti-inflammatory drug (NSAID) like Advil or Motrin (ibuprofen). More severe or persistent migraine attacks may require a triptan, such as Imitrex (sumatriptan).

Prevention

There is no surefire way to prevent migraines from developing after being diagnosed with seizures or vice versa. However, similar preventive strategies can help you control both disorders.

Trigger Avoidance

Since epilepsy and migraine share triggers, identifying and avoiding these triggers (if they affect you) could help you have fewer seizures or migraines. Starting a seizure and migraine diary, or downloading an app like Migraine Buddy or My Seizure Diary, can help you track potential triggers.

Healthy Lifestyle

Adopting healthy lifestyle habits can also improve your seizure and migraine control. Such habits include:

• Stick to a regular sleep schedule.
• Eat a well-balanced diet (consider meeting with a nutritionist for guidance on eating patterns that may help prevent seizures/migraines).
• Avoid or limit alcohol consumption.
• Stay active (consult with your healthcare team before starting an exercise regimen).
• Care for your emotional well-being and cope with stress (consider journaling, meditating, and massage).

Summary

Epilepsy and migraine are brain conditions with overlapping features. Having epilepsy increases your chances of developing migraine and vice versa. Complex genetic and environmental factors likely explain why the conditions sometimes coexist. There is no evidence that one directly causes the other.

Besides sharing triggers and symptoms, certain medications can treat both conditions simultaneously. Healthy lifestyle habits that avoid triggers may also help.