Migraine and Epilepsy: A Focus on Overlapping Clinical, Pathophysiological, Molecular, and Therapeutic Aspects

Abstract

The association of epilepsy and migraine has been long recognized. Migraine and epilepsy are both chronic disorders with episodic attacks. Furthermore, headache may be a premonitory or postdromic symptom of seizures, and migraine headaches may cause seizures per se (migralepsy). Migraine and epilepsy are comorbid, sharing pathophysiological mechanisms and common clinical features. Several recent studies identified common genetic and molecular substrates for migraine and epilepsy, including phenotypic-genotypic correlations with mutations in the CACNA1A, ATP1A2, and SCN1A genes, as well as in syndromes due to mutations in the SLC1A3, POLG, and C10orF2 genes. Herein, we review the relationship between migraine and epilepsy, focusing on clinical aspects and some recent pathophysiological and molecular studies.

The Prevalence of Migraine and Tension Type Headaches among Epileptic Patients

“…Our results are close to the prevalence of 5-15% for pre-ictal headache that was reported in epilepsy and of especially 11% in pharmacologically refractory partial epilepsy (29)(30)(31). Similar to our findings, in the other studies, post-ictal headaches are more common than pre-ictal headaches which are often the migraine type and especially occur after some types of epilepsy such as generalized tonic-clonic and occipital lobe epilepsies (1,29,32,33). Limitations of this study were small sample size, prospective nature of the study and undifferentiated epileptic syndromes.…”

“…Episodic attacks with the same triggers such as sleep deprivation, menstruation and alcohol drinking along with some common clinical manifestations such as visual aura and cognitive disturbance during attacks are among these similarities. Additionally common medications such as Sodium Valporate, Topiramate and Gabapentin are used for treating of both disorders (1,2). Their co-morbidity has been confirmed by several studies (1)(2)(3)(4)(5)(6).…”

“…Additionally common medications such as Sodium Valporate, Topiramate and Gabapentin are used for treating of both disorders (1,2). Their co-morbidity has been confirmed by several studies (1)(2)(3)(4)(5)(6). Ottman et al have postulated that the prevalence of migraine among patients with epilepsy is about 2.4 times higher than that of the normal population (7) and also the chance of migraine headache in epileptic patients is higher than the normal population (i.e.…”

“…bidirectional co-morbidity) (8). Headache may occur with close temporal relation before one epileptic seizure (namely pre-ictal or rarely during seizure: ictal) and more commonly after it (post-ictal headache) (1,6). However, many epileptic patients may have headache without temporal relation with seizure named inter-ictal headache.…”

Shared loci for migraine and epilepsy on chromosomes 14q12-q23 and 12q24.2-q24.3

“…This is somewhat unexpected, because MA is the type of migraine usually associated with epilepsy. 31 It is possible that some patients with MO will have their first attacks with aura later in their life, and the family phenotype thus will still become more aural. In addition to epilepsy and migraine, some family members had an interesting phenotype: SUA.…”