With migraine and epilepsy being so common, could the two be combined in some cases? What are true migralepsy symptoms?
Migraine and epilepsy are not only both common (meaning both may just happen to occur in the same person, without necessarily sharing a common cause), they share a lot of symptoms in common, and they also tend to be comorbid (having one makes it more likely that you’ll have the other).
But unravelling which is which, and when both may occur together, has been very controversial.
Since the brain is still such a mystery, both epilepsy and migraine remain challenging to treat and understand. We do know that certain types of epilepsy are more likely to appear along with migraine (such as benign rolandic epilepsy).
Certain conditions also may lead to both migraine-like headaches and seizures, such as leptomeningeal angiomatosis (Sturge Weber Syndrome), mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS Syndrome) or cerebral venous thrombosis.
The matter is further complicated because of other symptoms that migraine and epilepsy often share. For example, confusion, a changed perception of reality (how things smell for example), visual hallucinations (particularly shared by migraine and occipital lobe epilepsy) and changes in motor skills (such as motor weakness or stiffness). In fact, some forms of migraine are often misdiagnosed as epilepsy, such as hemiplegic migraine.
Headache Attributed to Epileptic Seizure
Perhaps the most common confusion comes from the fact that migraine-like headaches tend to show up around seizures frequently. But what does that mean? Is it just a headache from the seizure, or is it some combination of the two conditions?
You’ll see below two examples of what we call “headache attributed to epileptic seizure”, and only one description of “migralepsy”.
Symptoms and Diagnosis
This chart shows how symptoms are usually diagnosed when there is a seizure (or something that looks like a form of epileptic seizure). This is very simplified – of course you need to talk with a doctor who knows your medical history to get a proper diagnosis.
|Headache and seizure develop together, and resolve together.||hemicrania epileptica|
|Headache begins within three hours of the seizure and resolves within 72 hours. It may be a migraine (or migraine-like) headache, particularly in patients who also have migraine disease. Or it could mirror tension-type headache. This is very common.||post-ictal headache|
|Seizure occurs during or after migraine attack. This refers specifically to migraine with aura. What seems to happen is that the migraine attack begins with a visual aura. Then the seizure follows, either along with the headache or even afterwards.||migralepsy or migraine-triggered seizure
(two names for the same thing)
As you can tell even from the above chart, migralepsy symptoms are not so easy to differentiate from other conditions. Headache with a seizure? Could be migralepsy or hemicrania epileptica.
With all the shades of difference and related conditions, we certainly need more information before we can really understand the interrelation of the symptoms of migraine and epilepsy.
Just going by what we’ve talked about in this short article, migralepsy symptoms are extremely rare. In most cases, the jumbling together of migraine and epilepsy comes from post-ictal headache, or simply similarity of the symptoms (such as in forms of occipital epilepsy).