Migraine Seizures and Migralepsy

This rare migraine complication can be misdiagnosed

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A migraine-triggered seizure is a rare complication of migraine with aura. Also described as a migraine-aura triggered seizure or migralepsy, this type of event is different from a seizure-induced headache or migraine because the it's the migraine that causes the seizure, not the other way around.

It can be difficult to recognize these complex events, and experts are not completely clear on the best route of treatment. Strategies aimed at reducing migraine frequency and severity may prevent migraine-induced seizures from occurring.

Symptoms

The symptoms of a migraine-triggered seizure can begin with an aura, which is a migraine-associated neurological deficit. An aura can involve any of a number of neurological symptoms, including visual changes, weakness of one side of the face or body, sensory changes, and difficulty speaking. A migraine with aura can also involve head pain, but not always.

A seizure involves diminished awareness, involuntary movements of the body, or both.

Because seizures often interfere with consciousness, it can be difficult to remember the exact details of an entire migraine-induced seizure episode.

One of the recognizable features of a migraine-induced seizure is that the migraine symptoms occur before the seizure begins.

A seizure typically lasts for minutes, while a migraine may last for hours or days.

Causes

A migraine-aura triggered seizure is defined as a seizure that occurs due to a migraine with aura and is not observed in migraines without aura.

Experts suggest that migraine aura-induced seizures occur due to electrical changes in the brain that accompany an aura. Migraines have been associated with an electrical pattern described as spreading depression, but migraines with aura may involve additional alterations that produce their neurological symptoms.

It isn't quite clear why or how a seizure, which is typically associated with erratic electrical activity in the brain, develops in association with the aura phase of a migraine.

Diagnosis

The diagnosis of these events is challenging. There is a slight increase in the chance that you will experience migraines with aura if you have epilepsy. And seizures can trigger headaches or migraines during or after the seizure.

An electroencephalogram (EEG) may help differentiate a seizure caused by a migraine with aura from a migraine or headache caused by a seizure. But the chance that you would have an EEG during this type of event is very low, so diagnosis relies on your recollection of the event, descriptions provided by whoever was with you when it happened, and sometimes, by your response to medication.

Treatment

There are several treatment strategies for preventing migraine-induced seizures that may be explored, and you will need to see a specialist if you have this rare type of seizure.

If you have these events frequently, you need to adopt migraine prevention strategies as well. Your doctor may also prescribe medications to prevent your migraines and/or antiseizure medications.

Management is very individualized, and you may need to adjust your medication regimen over time due to the complexity of this condition.

Some antidepressants used in migraine prevention can increase the likelihood of seizures in people with epilepsy. Your doctor will select your migraine prophylaxis carefully to avoid this side effect.

Several anticonvulsants are used in migraine prevention. Using more than one anticonvulsant can amplify side effects such as fatigue and impaired coordination, so your doctor will consider these interactions when determining which medications, and which doses, are best for you.

Some strategies that have been used for managing refractory (resistant to standard treatment) migraine-triggered epilepsy include the ketogenic diet and the use of opioids. Neither of these alternatives is easy or ideal.

The ketogenic diet is a restrictive high-fat, no-carbohydrate diet that can be used to control some types of epilepsy. It is, however, associated with cardiovascular problems. And opioids cause drowsiness, difficulty concentrating, and come with a high risk of addiction.

A Word From Verywell

Migraines and seizures are both complex brain disorders. Both of these conditions cause intermittent attacks and interfere with your ability to function. Living with the overlap between the two conditions is especially challenging.

As you navigate the diagnosis and treatment of this rare medical condition, try to obtain as much information about your symptoms as possible. Keeping a headache or migraine diary, keeping track of your lifestyle triggers, and maintaining a consistent schedule with adequate rest and self-care may help control the frequency and severity of your events.

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