What You Need To Know About Seizures...

MIGRAINE

What You Need to Know About Migraine and Seizures

Sometimes migraine and seizure occur in the same person, but sometimes it’s just difficult to tell which a person is experiencing.

Becky Upham

By Becky Upham

Medically Reviewed by Jason Paul Chua, MD, PhD

When migraine symptoms don’t respond to migraine therapies, it may worth considering whether the person is really having seizures.Adobe Stock

Migraine attacks and seizures are both events related to the brain, but exactly how the two are related to each other is something that experts are still trying to unravel.

“There times when a patient experiences an event, and it’s not immediately apparent if they’ve had a seizure or a migraine,” says Lauren Doyle Strauss, DO, a headache specialist and an assistant professor at Wake Forest Baptist Health in Winston Salem, North Carolina.

“That’s because there can be an overlap in some of the ways that people describe both of those problems,” Dr. Strauss explains.

There is evidence that the two disorders are associated with each other: The prevalence of migraine in children with epilepsy — which causes seizures — is estimated at 8 to 24 percent, which is approximately double the risk found in the general population, according to a paper published in the Journal of Headache and Pain.

What Is Migralepsy?

Migralepsy is an older term that has been used to describe when a person has both migraine and epilepsy, says Strauss. The term was first used in a paper published in 1960 to describe a condition in which “ophthalmic migraine with perhaps nausea and vomiting was followed by symptoms characteristic of epilepsy,” according to a paper published in the Journal of Headache Pain.

This type of seizure, which is triggered by a migraine attack with aura, is considered a rare but real complication of migraine, according to the International Headache Society (ICHD-3).

A Seizure Can Be Part of Epilepsy or Migraine

To better understand the connection between migraine and seizures, it’s helpful to understand what a seizure is, says Strauss. “You could describe it as a sudden surge of electrical activity in the brain,” she says.

Johns Hopkins Medicine defines a seizure as “a burst of uncontrolled electrical activity between brain cells (also called neurons or nerve cells) that causes temporary abnormalities in muscle tone or movements (stiffness, twitching, or limpness), behaviors, sensations, or states of awareness.”

People are diagnosed with epilepsy after they have had two or more unprovoked seizures, according to the Centers for Disease Control and Prevention (CDC).

Seizures Are Different Depending on Where They Occur in the Brain

There are two categories of seizures: generalized seizures, which affect both sides of the brain, and focal seizures (also called partial seizures), which take place is just one part of the brain, according to the CDC.

Depending on which part of the brain is affected, that's the area that will manifest symptoms, explains Strauss.

“For example, if the area of the brain that controls your language is affected, then that makes sense that your language may not be normal during the seizure. It could cause you to stutter or have trouble with your words,” she says. Similarly, if someone had a seizure in the area of the brain that controls your vision, that may correlate with visual symptoms, says Strauss.

Just because the seizure begins in one part of the brain doesn’t mean it stays there. “A seizure can start in one area of the brain and can quickly spread to other areas or across the entire brain,” she says.

People can experience a seizure in a lot of different ways, says Strauss. “You can have a change in your awareness; others may notice that you're staring. You may have amnesia, where you forget or are unaware there's been a change in your surroundings, or you don’t even know that a seizure happened,” she says.

“Your whole body can shake — that's called a grand mal seizure, and it’s often what people think about when they when they think of seizure. You can also have shaking in one arm or just one leg,” says Strauss.

Can a Migraine Attack Cause Someone to Have a Seizure?

“We don’t fully understand what provokes a migraine and what provokes a seizure; it could be possible that something provokes both,” says Strauss.

Headaches can occur on their own and be unrelated to seizures, or a headache can be a symptom that happens before, during, or after a seizure, says Strauss. “We use the terms ‘preictal,’ which is before the seizure, ‘ictal,’ which is during the seizure, and ‘postictal,’ which is after the seizure,” she says.

Preictal and ictal headaches are relatively rare and usually don’t last long, according to the Epilepsy Foundation. Headaches that occur after a seizure are more common. A survey of 372 patients attending an epilepsy clinic found that 45 percent of them had experienced a postictal headache, and more than 1 in 5 always had one.

Is It a Migraine Attack or a Seizure?

“If a person is having migraine symptoms that aren’t responding to migraine therapies, and they have neurologic symptoms associated with the headaches, it’s reasonable to take a step back and say, ‘Are we sure these are migraines?’” says Strauss.

If you have a grand mal seizure, it’s usually clear that it’s a seizure, she says. “However, with focal seizures or partial seizures or complex partial seizures, these more subtle seizures where it's only affecting one part of the brain, it can be difficult to always know...

Everyday Health 

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