Blog #19: Are My Symptoms Seizures or Migraines--or Both?

(This blog was originally posted on February 8, 2012)

 

Epilepsy and migraine are episodic conditions. Both manifest their specific symptoms in stereotypical fashion, i.e., each attack is usually just like the previous one.

• Epilepsy occurs in almost one percent of the American population, and in one percent of the world’s population.

• Migraine is seen in approximately fifteen percent of people; seventy percent of migraineurs are women. Five-eight percent of young children suffer with migraine; higher percentages of older children and teenagers are affected.

• Of patients with migraine, six percent also have epilepsy.

• Up to twenty-six percent of people with epilepsy also have migraine (1, 2, 3).

The two conditions share genetic changes that occur in specific chromosomes. This fact strengthens the theory that there are common genetic factors in epilepsy and migraine headaches. More research is needed, though, to document this relationship (4). The specific cause of migraine is not known.

 

People with epilepsy frequently experience warnings before their seizures. These warnings often consist of numbness, weakness or jerking in various body parts, vertigo and confusion. Visual changes can also be experienced, such as seeing flashing spots and lines, or objects that appear distorted and altered in size. These can be auras—the warnings of seizures—or the actual seizure itself. They typically last several seconds to minutes and are often followed by the post-ictal confused state and headache.

Some or all of these same symptoms are also experienced during a migraine. Confusion is not typical although transient speech impairment can occur. Furthermore, pain does not always occur in migraine. If just these other symptoms are experienced without headache, they are diagnosed as migrainous phenomena. A positive family history of headache is typical in migraine. In contrast, epilepsy is far less associated with a family history of seizures.

A colorful example of migraine-induced altered vision can be found in the nineteenth century novel, Alice’s Adventures in Wonderland. Its author, Lewis Carroll, reportedly suffered from migraine. In the novel, Alice became a tiny person who encounters a strange wonderland—probably a product of migrainous illusions.

Epilepsy and migraine don’t usually cause diagnostic changes on brain scans. However, specific abnormalities may occur in the electroencephalogram (EEG) in epilepsy that are not found in migraine. Differentiating the subtle symptoms of epilepsy from migraine can be very challenging for the clinical neurology specialist.

Of interest is the fact that certain anti-seizure medications are very useful in controlling both migraine and epilepsy.

 

1.      Bigel ME, Lipton RB. The epidemiology, burden, and comorbidities of migraine. Neurol Clin 2009; 27: 321-334.

2.      Marks DA, Ehrenberg BL. Migraine-related seizures in adults with epilepsy…Neurology 1993; 43: 2476-2483.

3.      Ottman R, Lipton RB. Comorbidity of migraine and epilepsy. Neurology 1994; 44:2105-2110.

4.      Polvi A, Siren A, et al. Shared loci for migraine and epilepsy on chromosomes… Neurology 2012; 78: 202-209

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel.