Migraine and Epilepsy

Discovering the Nature of the Relationship
April 10, 2017
Jim Carleton
"Epilepsy is more than a seizure. It's a life changing and threatening condition affecting the person and their families terribly." (Julie Clark, Scotland, UK, 2017) 

 

We can easily substitute migraine and headache into that quote . The result would be a commonly acknowledged expression assigned to migraine disease:  Migraine is more than a headache... which is also life changing and affects people's lives terribly. Coincidence? Probably not.  It brings us to the crux of a significant medical-neurological question and the focus of this newsletter:  what is the nature of the relationship between migraine disease and epilepsy disorders?

 

The choice for the monthly newsletter topic is informed by our followers. Much interest has recently surfaced in this area. Migraine, which is known for its wide range of co-morbidities, has been shown to be significantly associated with epilepsy. But do the two conditions have a common, underlying, neurological basis? Research is being focused in that area, and should it bear fruit, the treatment of both conditions could be enhanced. A good place to start is similarities between the conditions:
  • Both conditions experience a phenomena called "cortical spreading depression", although migraine propagates more slowly
  • Certain medications are effective in treating both disorders
  • Stress can trigger both migraines and seizures
  • There is a demonstrated genetic susceptibility to both migraine and epilepsy
  • Numerous migraine symptoms, such as numbness in the arm or face, can also appear to be a seizure-related symptom.
  • People with seizure disorders are twice as likely to experience migraines
  • Each condition is generally acknowledged as under-treated, and both are often misdiagnosed
This brings us to the point of temporal proximity. Do two conditions existing very close together in time suggest anything more than a relationship of association? "Migralepsy" (migraine triggered seizures) is a poorly defined entity that attempts to bridge this temporal gap, and the oft-criticized definition of this condition is far beyond the scope of this short newsletter.  However, the struggles of attempting to define a condition that lives in the borderland of epilepsy and migraine should not be lost on us.

 

Perhaps we can borrow a term from our legal lexicon, in this case "circumstantial evidence".  This is evidence that relies on inference to draw a conclusion.  Unfortunately, about 66% of all epilepsy cases have no known cause,  and must rely on some form of inference for explanation.  Seldom do disorders such as migraine, epilepsy, anxiety, depression, and suicidiality exist in a vacuum. Somehow they are interrelated, and the explanation is now one of inference. Perhaps Winawer, a major proponent of shared genetic susceptibility between migraine and epilepsy, states it best: "We really need to understand epilepsy in its context".  "There is a huge move in the last few years to do that and I think this work is part of the larger question".

 

Any process or legislation that serves to reduce the volume of robust, peer-reviewed research can only be viewed as obstructionist to helping solve these often life or death questions, let alone quality-of-life determinations. Are migraine and epilepsy separate neurological disorders? Probably not, but only solid research will provide us with a definitive answer.