epilepsy

28 February 2024

Headache in Epilepsy Patients: Let’s talk about triggers.

The connection between headache and epilepsy is no secret. The challenge is that both symptoms often emerge from deep in the brain – an organ so incredibly complex that we’re really only starting to understand it.

Epilepsy, migraine, headache, and seizures...

A recent study investigated triggers of seizures and also headaches in patients with seizures. Might the same things be triggering both? If so, might this point to a connection in what causes both? (More information here: Exploring Shared Triggers and Potential Etiopathogenesis between Migraine and Idiopathic/Genetic Epilepsy)

The study was published this month in the journal Clinical Neurology and Neurosurgery. 809 patients who had epilepsy were studied – in this case, patients who had genetic related epilepsy or epilepsy with no known other cause (idiopathic).

Researchers found that there were indeed some similar triggers. Patients most often cited stress as a trigger for both seizures and headache. As we’ve talked about before, “stress” is not a simple cause – stress is, in fact, related to all kinds of physical and lifestyle factors, which makes it very difficult to study.

But that brings us to the second most commonly reported trigger for both – sleep deprivation. And this was related to #3 on the epilepsy list, fatigue.

All of these things could speak to getting out of your normal routine and not getting enough rest. That’s not to say the patient is to blame necessarily – there are 100 reasons this may occur, many of them completely out of our control, as we all know from experience.

One more interesting note. Patients with migraine and epilepsy were also more likely to have menstruation-triggered seizures (catamenial epilepsy). This naturally makes researchers ask questions about hormone fluctuations and both conditions. And yes – in some women sleep problems do go along with that time of the month.

The researchers in this study were especially interested in asking questions about a shared cause of headache/migraine and epilepsy. But there’s a practical point here too. Patients and their doctors can fight back by focusing on these triggers – in particular, sleep schedules. That may mean identifying another condition (such as a sleep´disorder), or working on changing environmental or lifestyle factors that can improve sleep. For some people, improving sleep may mean a significant lessening of other symptoms.

3 February 2023

Migraine and “Altered Consciousness”

James Discoveries & Stats 0

You’re more likely to associate altered consciousness with conditions like epilepsy, or something sudden like a stroke. But sometimes the diagnosis should be migraine.

Migraine certainly can feature some unusual symptoms, and different levels of consciousness is one of them. This is most often associated with a type of migraine called migraine with brainstem aura. But because it’s unusual, it can lead to misdiagnosis, as happened recently.

A 16-year-old was experiencing attacks where she would get a severe, throbbing headache with vertigo. She would fall down, and even temporarily lose the ability to speak. Then the episode would pass.

Not surprisingly, an EEG was ordered, and she was diagnosed with a kind of epilepsy. But the medications for epilepsy didn’t work – and the attacks continued, 2-5 times a month.

Finally, the diagnosis was changed to migraine – and migraine treatments did work.

There is a lot of discussion about the relationship of migraine with epilepsy. And sometimes the differentiation isn’t as clear as we would like. Research certainly needs to continue, so that we can understand both conditions better.

But in the meantime, the important thing for patients is finding a treatment that works. If the common treatments for something aren’t working, it would be a good time to rewind and take another look at the symptoms, and also the medical history of the family (in this case, the patient’s mother did suffer from headaches).

Headache specialists and researchers may be interested in looking at more of the technical details of this particular case. It was published this month in Acta Epileptologica: A case of migraine misdiagnosed as epilepsy.

29 July 2021

New Neurodegeneration Research and Migraine

James Discoveries & Stats 0

New research into neurodegeneration may give us clues to new migraine treatments, along with ways to fight Parkinson’s disease, Alzheimer’s disease, and epilepsy.

The RobustSynapses project based in Europe has been involved in research which may indeed shed new light on a number of diseases. Patrik Verstreken of the Leuven Brain Institute in Belgium leads the team that has been using both fruit flies and human cells to study the systems that lead to degeneration in the brain.

Neurodegeneration is a very general term, but it is what it sounds like – a loss of function primarily in the neurons. So the RobustSynapses project is looking into how this function is lost, and how it can be restored.

To picture it in a very simple way, cells have sophisticated symptoms in place to “take out the garbage”. But what if there’s too much garbage? What if there is a genetic defect that causes more problems? What if the stinky mess starts spreading from cell to cell, across the brain? These issues can start to cause traffic problems, and so communication problems. Your sleep may be disrupted, or you might have trouble thinking, or you may experience pain when you shouldn’t.

You might say that this is very “close-up” research, looking at the function of individual cells, and the structure of proteins.

For example, the team discovered a specific problem with certain neurons that regulate sleeping patterns. There was a lack of a certain lipid (fat) (phosphatidylserine – found in tuna and white beans, for example), which may explain sleep problems in Parkinson’s patients (problems that sometimes show up much earlier than other symptoms).

Problems in certain cells might show up before the actual disease is very widespread, which means that these discoveries could lead not only to corrective measures (such as, perhaps, diet changes or a supplement to improve sleep in Parkinson’s patients), but actually preventing the progress of a disease.

Migraine and tension-type headache and their symptoms also show up on the cellular level. And we already know that there are some links between migraine, headache, and conditions such as dementia and Parkinson’s.

You can read more about the RobustSynapses project in this article from the European Commission: Brain study opens door to potential new disease treatments.

21 August 2017

Migraine and Mitochondrial Disorders

James Discoveries & Stats 0

We’ve talked before about the relationship between migraine and mitochondrial disorders (see Fight Migraine: Be nice to your Mitochondria. Not only commonly known mitochondrial diseases, but also disorders related to mitochondrial DNA (mtDNA), have a strong relationship to migraine.

Migraine and mitochondrial disorders These include gastrointestinal disorders, such as irritable bowel syndrome, and problems like gastric stasis (a challenging problem in migraine because your medication isn’t properly absorbed).

Many people with mitochondrial disorders do have migraine – but is this really a higher amount than the general population? An Italian study published earlier this month says “yes”.

93 patients were a part of the study, each with a mitochondrial disorder, such as progressive external ophthalmoplegia (a condition causing weakness in the eye muscles), myoclonic epilepsy with ragged red fibres (a condition typically causing muscle twitches, weakness, and progressive stiffness), and mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (with symptoms such as muscle weakness and pain, headaches and seizures).

35.5% of these patients had migraine. That’s well over the numbers typically cited for the general population – about 15%. Most commonly, this was migraine without aura.

There were a few other interesting notes. Patients with epilepsy, stroke-like episodes, and myoclonus (muscle jerking) were more likely to have migraine. However, migraine patients were less likely to experience muscle weakness, or to have abnormalities in EEGs.

There is increasing interest in how problems with the mitochondria may affect our health. And now we have more evidence that migraine may be related to those problems.

Read the study abstract here: Migraine in mitochondrial disorders: Prevalence and characteristics

13 February 2017

Migraine and Epilepsy: A Common Target?

James Discoveries & Stats 0

Migraine and epilepsy have a lot in common. For example, there are genetic connections. Epilepsy drugs are often used to treat migraine. And patients with one disease are likely to have the other as well.

Migraine and Epilepsy: A Common Target One interesting connection between migraine and epilepsy is the “cortical spreading depression” (CSD). CSD is a kind of electrical storm that passes through the brain of a migraine patient. It’s also been observed after a traumatic brain injury, and in patients with malignant strokes.

As you may have guessed, CSD has also been observed in patients with seizures. So – could we just target the CSD, and get rid of both the seizures (in some patients) and migraine attacks (in others)?

One of the tricks is that the CSD is not nearly as predictable in patients with epilepsy as it is in patients with migraine (although we still have a lot to learn about its role in both diseases). Does the CSD occur before the seizure, during, or after? Well – yes, it could be any of those three. So – is it a cause, or is it actually a protective measure? Sometimes it does seem that the CSD can put up a wall to stop the seizure in the brain. Other times, it seems to prepare the brain for the next seizure.

The brain seems to use the CSD in some interesting ways that we’re just beginning to understand. But some researchers of both migraine and epilepsy are hopeful that we may be able to use our growing knowledge of this “brain storm” to help the brain heal and avoid future attacks, whether they be migraine attacks or seizures. One treatment that is being studied and used today is vagus nerve stimulation, which may actually inhibit the CSD. It’s hopeful that more treatments will be developed for both diseases, and maybe the cortical spreading depression will be the common target.

For a more in-depth discussion, see Interplay between Cortical Spreading Depolarization and Seizures