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Migraine and Epilepsy: What’s the Connection?

Updated on November 29, 2021
Medically reviewed by
Evelyn O. Berman, M.D.
Article written by
J. Christy McKibben, LPN

Both epilepsy and migraine are common neurological disorders. Studies have shown that the two disorders appear to be comorbid (occur together). In fact, having a seizure disorder may make you twice as likely to have migraine headaches.

Here is what you need to know about migraine headaches with epilepsy, including how the disorders are related and how the symptoms of migraine can be managed. Talk to your neurologist if you experience migraine headaches with your epilepsy — they will work with you to find the best way to treat your headaches.

The Connection Between Migraine and Epilepsy

Many studies have pointed to an association between migraine and epilepsy. Most comorbidity studies have looked at the occurrence of new cases of migraine in groups of people with epilepsy. The prevalence of migraine in people with epilepsy has been estimated to be between 8 percent and 24 percent — about twice that of the general population.

Epilepsy shares some of the same features as migraine. For instance, many factors that trigger epilepsy can also lead to migraine attacks, including alcohol, stress, fatigue, and menstruation. The auras (sensory, visual, or speech disturbances) associated with each condition are also comparable. Electroencephalograms, a type of imaging test, can even show similar brain activity during a seizure and a migraine attack. Some doctors have debated whether a migraine could lead directly to a seizure, making it a pre-ictal headache (a headache that happens before a seizure).

There also appears to be a genetic component to the relationship between epilepsy and migraine. Research has shown that epilepsy may be connected to hemiplegic migraines (migraine attacks that cause one-sided motor impairment) in particular. In families with familial hemiplegic migraine type 2, for instance, the incidence of seizures is approximately 20 percent. The connections between epilepsy and different types of hemiplegic migraines are thought to arise from genetic mutations in the CACNA1A, ATP1A2, SCN1A, and PRRT2 genes.

A Closer Look at Migraine

Migraine is a type of headache disorder. These recurrent headaches are among the most common disorders of the nervous system. However, migraine is not just headaches. Migraine attacks can cause severe head pain and a host of other symptoms, like nausea and sensitivity to light or sound. Migraine attacks can be triggered by light, smell, fatigue, stress, alcohol, menstruation, sound, and movement. Symptoms of migraine include:

  • Throbbing, one-sided head pain
  • Visual auras
  • Temporary loss of vision
  • Nausea
  • Vomiting
  • Tiredness
  • Irritability
  • Tingling and numbness
  • Difficulty speaking

Different factors can trigger migraine attacks in a person with epilepsy. One MyEpilepsyTeam member shared of their migraine headaches, “Mine are all weather-related — and they are chronic!”

There are two general types of migraine: common migraine (migraine without aura) and complicated migraine (migraine with aura).

Common Migraine (Migraine Without Aura)

Migraine without aura causes pain on one side of the head. To be diagnosed with common migraine, a person must have had a minimum of five attacks, with each lasting between four and 72 hours. They must also have experienced photophobia (sensitivity to light), phonophobia (sensitivity to sound), nausea, or vomiting.

Complicated Migraine (Migraine With Aura)

Complicated migraine causes a period of visual and sensory phenomena known as an aura. Approximately 25 percent to 30 percent of people with migraine experience auras. As with epilepsy auras, migraine auras may include visual disturbances — such as seeing zigzag lines, strobe-like lights, sparkles, or dots — or physical sensations, such as numbness or tingling.

“Migralepsy” refers to a seizure that follows a routine migraine aura, typically within an hour of the aura.

Hemiplegic Migraine

Hemiplegic migraine is a kind of complicated migraine that causes an individual to have one-sided motor impairment (such as muscle weakness). The person will also have an aura before the migraine.

Familial hemiplegic migraine (FHM) is a form of hemiplegic migraine that’s inherited (passed down from parents to their children). This form of migraine begins in adolescence or even in childhood.

FHM is classified into four subtypes based on genetic causes:

  • FHM type 1 (most common) — Caused by mutations in the CACNA1A gene and typically connected with cerebellar degeneration
  • FHM type 2 — Caused by mutations in the ATP1A2 gene
  • FHM type 3 — Caused by mutations in the SCN1A gene
  • FHM type 4 — Diagnosed if FHM is caused by an unknown genetic mutation

The Impact of Migraine on People With Epilepsy

Migraine headaches can be debilitating. As one MyEpilepsyTeam member shared, “I get frequent migraines that leave me feeling miserable. I start to feel like the room around me is spinning, and that’s when I know that I’m having an episode. Sometimes just sitting down helps me, but on occasion, it leads to me blacking out for several minutes. When I wake up, I often don’t remember what happened or what I was doing before I blacked out.”

Headaches can occur before seizures (known as pre-ictal headaches), after seizures (postictal headaches), or even during seizures (ictal headaches). Migraine headaches are a specific type of headache that can occur alongside epileptic seizures. For example, tonic-clonic seizures are commonly followed by migraine headaches.

You may experience migraine attacks before or after seizures. As one MyEpilepsyTeam member shared of their migraine headaches, “Have had a few after this past seizure.”

Migraine episodes can last for several hours, days, or even weeks. One member described their long-lasting migraine: “I’ve had a migraine now for three weeks; two seizures last week. I go through this all the time, and it’s hell.”

Treating Migraine With Epilepsy

If you experience migraine attacks with your epilepsy, talk to your neurologist. They can help you treat and manage the symptoms of your migraine.

Therapies and treatments for migraine aim to prevent future attacks and alleviate the symptoms you experience during an attack.

Medications

Many medications are available for the treatment and prevention of chronic migraine. The treatment options your doctor may recommend will likely depend on the frequency of your migraine attacks, their severity, whether they cause vomiting and nausea, and any other health conditions you might have.

Migraine medications fall into two general categories.

Medications for Migraine Symptom Relief

These medications are taken during or before migraine attacks to alleviate or reduce symptoms. One MyEpilepsyTeam member shared, “I get constant migraines but get some relief from medication.”

Many different types of medications can be used to manage migraine symptoms. These drugs include:

  • Prescription or over-the-counter pain relievers
  • Triptans
  • Calcitonin gene-related peptide receptor antagonists
  • Anti-nausea medications

Medications for Migraine Prevention

These medications are taken regularly to reduce the frequency or severity of recurrent migraine attacks. If you’ve had severe, long-lasting, frequent headaches that haven’t responded well to other treatments, your doctor may recommend drugs such as blood pressure medications. Antiepileptic drugs like Qudexy (topiramate) and Depacon (valproate sodium) may also help.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a type of psychotherapy that can help a person understand how their thoughts and behaviors affect their perception of pain. CBT may help you better cope with common migraine triggers, including stress. CBT may also help you cope with anxiety or fear surrounding migraine attacks.

Biofeedback Training

Biofeedback training is a relaxation technique that uses special equipment to monitor your body’s physical responses to stress (such as muscle tension), allowing you to adjust your responses in real time. According to the American Migraine Foundation, this migraine therapy typically results in a 45 percent to 60 percent improvement in the severity and frequency of migraine headaches. Though biofeedback requires attending regular sessions, this option can be very successful in treating migraine alongside medications.

Make Yourself Comfortable

If you feel a migraine attack coming on, try to get to a dark, quiet room. Close your eyes and rest. Nap, if you can. Put a cool cloth over your forehead, and be sure to keep drinking lots of water.

Follow Eating and Sleeping Routines

To help alleviate pain from migraine, the Mayo Clinic recommends sticking to an eating and sleeping schedule — that means you should eat meals, go to bed, and get up at the same time each day.

A study of almost 300 people with migraine found that more than 85 percent of participants reported getting poor quality sleep — a factor that has been linked to more frequent headaches. Practicing good sleeping habits (referred to as sleep hygiene) can help improve the quality of your sleep. These habits include going to bed and getting up at the same time each day, avoiding alcohol and caffeine before bed, and keeping electronic devices out of the bedroom.

Stay Active

Stress is a common migraine trigger. Getting physical activity can help reduce tension, alleviate stress, and generally improve your mood. Regular exercise may even help prevent migraine. Aerobic exercise, in particular, can help reduce the number of migraine days people experience.

It is important to note that some people experience exercise-induced migraine. More research is needed to determine how the frequency and intensity of exercise may contribute to these migraine attacks.

Keep a Migraine Diary

Some people with migraine record their symptoms in a journal. Keeping track of migraine symptoms and factors such as stressors, eating and sleeping habits, and physical activity can help you and your doctor uncover patterns in your migraine to better direct your treatment plan.

Acupuncture

Some clinical trials have suggested that acupuncture may be helpful in reducing the frequency of migraine headaches. During acupuncture, an acupuncturist inserts multiple thin needles in specific areas of the body, called pressure points. Stimulating these pressure points is thought to activate parts of the brain that “turn off” the pain response.

Find Your Team

MyEpilepsyTeam is the social network for people with epilepsy and their loved ones. Members come together to share support, advice, and stories from their daily lives with others who understand.

Do you experience migraine attacks? How have you managed them? Share your experiences and tips in the comments below or by posting on MyEpilepsyTeam.

References
  1. Epilepsy — Mayo Clinic
  2. Migraine Facts — Migraine Research Foundation
  3. Seizures and Headaches: They Don’t Have To Go Together — Epilepsy Foundation
  4. Migraine and Epilepsy — Shared Mechanisms Within the Family of Episodic Disorders — Jasper’s Basic Mechanisms of the Epilepsies
  5. Headache Disorders — World Health Organization
  6. Migraine Headaches — Cleveland Clinic
  7. Migraine Without Aura — American Migraine Foundation
  8. IHS Classification ICHD-3 — Migraine Without Aura — International Headache Society
  9. Understanding Migraine With Aura — American Migraine Foundation
  10. Epilepsy Auras — Epilepsy Society
  11. Case Studies in Headache Archive — A Case of “Migralepsy” — National Headache Foundation
  12. Familial Hemiplegic Migraine — National Center for Advancing Translational Sciences
  13. Electroencephalogram (EEG) — Johns Hopkins Medicine
  14. The Genetic Relationship Between Epilepsy and Hemiplegic Migraine — Neuropsychiatric Disease and Treatment
  15. Migraine — Mayo Clinic
  16. What Is Cognitive Behavioral Therapy? — American Psychological Association
  17. An Integrative Cognitive Behavioral Therapy Program for Adults With Migraine: A Feasibility Study — Headache
  18. Biofeedback and Relaxation Training for Headaches — American Migraine Foundation
  19. Exercise and Stress: Get Moving To Manage Stress — Mayo Clinic
  20. The Association Between Migraine and Physical Exercise — The Journal of Headache and Pain
  21. The Effect of Aerobic Exercise on the Number of Migraine Days, Duration, and Pain Intensity in Migraine: A Systematic Literature Review and Meta-Analysis — The Journal of Headache and Pain
  22. Sleep Disturbance and Affective Comorbidity Among Episodic Migraineurs — Headache
  23. Tips for Better Sleep — Centers for Disease Control and Prevention
  24. Acupuncture and Migraine: Finding a Combination That Sticks — American Migraine Foundation
All updates must be accompanied by text or a picture.
Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
J. Christy McKibben, LPN is a freelance writer and licensed practical nurse in North Carolina. Learn more about her here.

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